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THE 'f 



MEDICAL AND SURGICAL 



REPORTER 



A. ^v^^EEK:LY JOXJR]SrA.L 



EDITED BY 



S. W. BUTLER, M. D., AND R. J. LEVIS, M. D. 



OCTOBER, 1860— APRIL, 1861. 



YOL. ¥. 



PHILADELPHIA: 

CEISSY ^. MARKLEY, PRINTERS, GOLDSMITHS HALL, 

LIBRAET STREET. 

186L 



13^ r> EX. 



Abortion, its medical and moral aspects, 443. 
Abscess ; of broad ligament, 203 ; communicating 

■with pleura, 204 ; in axilla — safe method of open- 
ing, 256. 
Acarus or scabies mite, microscopia of, 585. 
x\ccidents, street in Paris, 464. 
Acclimating races ; impossibility of, 623. 
Acupressure, Velpeau's opinion of, 24. 
Acute diseases, remarks on views of Dr. Todd on, 

388. 
Adulteration of milk, 625. 
Albuminuria, 396 ; remarks on, 523 ; pathology of, 

613 ; case of, 642. 
Alcohol ; consumption of, 23 ; as a remedial agent, 

343. 
American Medical Association, 600 ; need of a per- 
manent secretary for, 624. 
Amputation ; through foot, 368 ; of hand, 429, 447 ; 

of thigh, 644. 
Anatomy in its relations to Medicine and Surgery, 

82, 138, 219, 327, 439, 470, 551, 677. 
Ansssthetics, Hall's method in suspended respiration 

from use of, 598. 
Anchylosis; of elbow-joint, 199; of knee-joint, 644. 
Aneurism; popliteal, 169; subclavian, 204; of 

aorta, 35, 142, 229, 231, 280, 394, 505, 533, 634, 

643. 
Animal magnetism, note on, 406. 
Ankle-joint, chronic disease of, 646. 
Antrum, fibro-melanoid tumor of — removal, 4. 
Aorta, aneurism of, 35, 142, 229, 231, 280, 394, 

505, 533, 634, 643. 
Aparatus for local application of vapors, (without,) 

67. 
Apples, chemical composition of, 267. 
Army and navy, medical service in, 633. 
Arsenic ; poisoning by, 103, 628 ; in china, 233 ; 

suspected poisoning with, 407 ; suicide attempted 

by, 462 ; in paper hangings, 692 ; over doses of — 

poisoning — good effects of iron, 709. 
Arsenical waters, 127. 
Ascaris lumbricoides entrapped, 284. 
Ascites, extraordinary case of, 35. 
Asthma, 536 ; from cardiac disease, 563 ; from 

emphysema, 564. 
Atmosphere, phosphorus in, 350, 
Atropine, poisoning by, 110. 
Aural surgery, cases in, 161. 
Axillary luxation, reduction of, by manipulation, 

531, 587. 



Barton's fracture, new method of treating, 609. 

Beard question, 234, 262, 488, 659. 

Bed case, 491. 

Bee hive, hygrometric condition of, 267. 

Bees, death by, 23. 

Belladonna, in inflamed mammae, fauces, etc., 137 ; 

solution of in glycerine, 459. 
Birth, premature — foetus, 255 ; quadruple, 143, 195. 
Births; and deaths in New York, 130 ; marriages and 

deaths in Philadelphia, 465. 
Bladder, stone in, 61. 
Blindness, is it caused by rice? 263. 
Blood-stains, to distinguish, 22. 
Boa-constrictor, tanned skin of, 156. 
Bone, protrusion of, by .growth from end of stump, 

183. 
Bone-setters in France, 128; prosecution of a, 184, 
Brain ; lecture on chronic softening of, 1 ; incipient 

softening of, 39 ; concussion of, and injury of 

pneumogastric nerve, 67 ; injury of, 230. 
Breast, cancer of, 60, 336, 337, 339, 451, 619, 
Breeding of tape worm, 711. 
Bronchitis; chronic, 230, 251 ; mullein in, 163; 

two cases of, 202 ; chronic capillary, 397 ; severe, 

475. 
Burns, cure for, 23. 

Csesarean section — post mortem, 170. 

Calculi in bladder of dog and turtle, 622. 

Calculus; mulberry, 231; removal of, from urethra, 
685. 

California, influence of climate of, on prolificity, 694. 

Cancer ; of breast, 60, 336, (18 operations, 34 tu- 
mors removed,) 337, 339; epithelial of lip, 142, 
452; of tongue, 176; of penis — amputation by 
the ecraseur, 204 -, of womb, 330 ; of eye, 337 ; 
medullary of antrum — removal with bony and 
soft, parts, 432 ; encephaloid of mamma — removal, 
451; of testicle, (lecture,) 467 ; of lip, neck, leg, 
590; removal of medullary, 591; scirrhus of 
breast, 619. 

Candle, chemical history of, 662. 

Carelessness, professional, 705. 

Carmine, action of, on organic cells, 344. 

Cataract; lectures on, 27, 53, 79,187, 215, 411; 
cases of, 88, 479, 508 ; an operation for, restoring 
sight and reason, 143 ; summary of, in Wills Hos- 
pital, 279 ; lenticular, 279 ; false, 279 ; extrac- 
tion of capsules by Wilde's canula forceps, 280. 
See also Wills Hospital. 



av 



INDEX. 



Cattle, improved mode of slaugbtering, 125. 
Cephalalgia, from congestion, 506. 
Cerebral substance, color of, in relation to external 
pigment, 155. 
trouble in a child — curious case, 342. 
Cerium, oxalate of, in vomiting of pregnancy, 154. 
Chemist to his love, 6G0. 
Chilblain, 436. 
Chinese pharmacopoeia, 156. 

Chloroform; death from, 42, 69 ; annoyances of ad- 
ministration of, 143 ; remarks on administration 
of, 311 ; in poisoning by strychnia, 687. 
Chlorosis in children, 93. 
Chorea, 278, 396. 
Choroid, tumors of — extensive disease — extirpation 

of eye, 231. 
Cimicifuga, therapeutical and pharmaceutical notes 

on, 531. 
Circocele, operation on, by subcutaneous ligation — 

with remarks, 566. 
Cities, mortality of, 236. 
Clavicle, fracture of, and sternum, with wound of 

lungs, 12. 
Climate of Pekin, 493. 

Clinical instruction in Philadelphia and Pennsylva- 
nia Hospitals, 151. 
Clot on dura-mater, 255. 
Club-foot, 88 ; division of soleus in, 618. 
Colchicum, experiments relating to diuretic action 

of, 595. 
Colic lead, remarks on, 607. 
Colles fracture, new method of treating, 609. 
Colon, constriction of, 254, 
Condyles of femur, resection of, 206. 
Confectionery, poisoned, 266. 
Consumption, new cure for, 128. 
Convulsions ; epileptiform, 227 ; followed by paraly- 
sis — recovery, 249-50. 
Copper, arsenite of, in dye-stuffs, 131. 
Cornea, staphyloma of, 647. 
CoRKESPONDENCE, (Foreign.) 

Letter from Glasgow, 20 ; letter from Edinburgh, 
98; letter from London, 124; letter from Paris, 
150,238; letter from London, 179; letter from 
Madrid, 518, 574; letter from Cadiz, 627; 
letter from Malaga, 693. 

CoKRESPOjiDExcE, (Domestic.) 

Dishonorable mercenary arrangement between 
physicians and apothecaries, 19; tannin as an 
antidote to strychnia and narcotic irritants, 20. 

Collusion between physicians and apothecaries, 
44, 75 ; esthetics of pill making, 45; letter 
from Alabama, 45. 

Mortality statistics — Letter from Dr. Griscom, 
72; mortality in Philadelphia, 99. 

Letter from New York, 125. 

Revoking diplomas, 148; intermittent spasms 
with albuminuria — good effects of quinine and 
opium, 149. 

Medical societies in New York, 180; tetanus in 
a child from a calculus in ureter, 181 ; a stu- 
dent's complaint, 182. 

The new degree, 239. 

Digitalis in scarlatina, 202 ; the beard question, 
262 ; extensive wound involving three meta- 
carpal bones — speedy union, 263 ; digitalis in 
delirium tremens— duel— wound, 263; does rice 



cause blindness ? 263 ; the new title— a propo- 
sal, 264 ; another " lock jaw" case, 264. 

The new degree, 294 ; discoloration of foetus and 
foetal membranes, 294. 

The new degree, 322, 

Entomology pins, 348 ; reduction of dislocation 
of shoulder of four months' standing, 349 ; ma- 
ternal impressions, 349 ; uterine hydatids, 349. 

Artificial respiration not to be used in resuscita- 
ting still-born children, 377 ; letter from New 
York, 877 ; discoloration of foetus and foetal 
membranes, 378, 

Vital induction, commonly called animal magne- 
tism, 406 ; suspected poisoning by arsenic, 407. 

The ether patent, 436 ; medical education, 436 ; 
chilblains, 436. 

Attempted suicide by arsenic — unusual symp- 
toms, 462. 

Massachusetts correspondence — bed case, 491. 

Esematemesis, 519 ; a peculiar case, 520 ; in- 
fluence of poison of variola, 520. 

Massachusetts correspondence, 549, 575, 602, 625, 
657, 691 ; diphtheria a specific disease, 549. 

Method of treating syncope and asphyxia of new- 
born children, 575, 

The recent examination in the Central High 
School — letter from Dr, Vogdes, 601 ; errors in 
Minutes of American Medical Association, 603 ; 
pathology of tubercle and treatment of phthisis, 
604. 

Omental tumor. 694. 

Diphtheria, 708 ; over-doses of arsenic — poison- 
ing — good effects of iron, 709. 

Cotton as under-dress, 634. 

Cough and expectoration, importance of, as symp- 
toms of tuberculosis, 557. 
Cow-pox, new experiments regarding origin of, 652. 
Cranium, imperfect development of, in a foetus, 164. 
Croup, tracheotomy in, 323, 
Crystals, formation of, 184. 

Deafness; from thickening of mem. tympani and 
disease of Eustachian tube, 161 ; from mucus ac- 
cumulation in Eustachian tube, 162. 

Death, curious, 241, 

Debility, doctrine of, and treatment of disease by 
stimulants, 284, (discussion,) 313. 

Deformity ; of face from abuse of mercury, 450 ; of 
lower extremities — operation, 451. 

Degree, the new, 208, 239, 264, 294, 322, 548. 

Delirium; consequent on over-excitement, 514; tre- 
mens, digitalis in, 65, 154, 158, 263, 592. 

Dental College of New Orleans, 711. 

Deodorant, the best, 664. 

Diagnosis, ridiculous mistake in, 182, 

Digitalis; large doses of, in delirium tremens, 65, 
154, 158, 263 ; in scarlatina, 262, 324 ; therapeu- 
tical uses of, 371, 

Diphtheria, 282, 373, 513, 627, 708; lecture on, 355, 
383 ; heart clot in — report on, 399 ; report on, 
456 ; a specific disease, 549 ; in valley of Vir- 
ginia, 616, 

Diplomas, revoking, 68, 148. 

Disease, physiognomy of, 189 ; of printers, 463. 

Diseases, epidemically and epizootically in United 
States in 1860, 135, 193, 275, 800. 

Dislocation of shoulJer-joint — reduction by manipu- 
lation, 349, 497, 587. 



INDEX. 



Diuresis, excessive, 449; following sun -stroke, 504. 

Doctor, a learned, 23. 

Doctor's model ^vife, 695. 

Dropsy; acute renal, 398; what is the proximate 

cause of ? 613. 
Dysentery, chronic, 335. 
Dyspepsia, 203, 229. 

Ectropion, prevention of, 409. 
Ecraseur, amputation of penis by, 204. 
Edinburgh,- medical matters in, 98. 
Editorials : — 

The fifth volume, 10 ; status of American medical 
literature, 16; the chemistry of quacks, 18; 
mortality statistics, 19. 
Experimental physiology, 40 ; death from chloro- 
form, 42; spirit of medical press, 43, 71, 97, 
123, 179, 261, 292, 406, 435, 491, 517, 573. 
Revoking a diploma, 68 ; still another death from 
chloroform — shall its use continue ? 69 ; medical 
progress in Illinois, 69 ; mortality tables, 70 ; 
substituting non-officinal for officinal prepara- 
tions, 71. 
tempora ! mores, 94 ; medical jurisprudence, 

96. 
What is our duty? 122; Philadelphia Hospital, 

123 ; mortality statistics, 123. 
Organization, 145 ; timely revolutions, 146 ; 
mean politics, 147 ; mortality of cities, 147, 
236. 
Science Cosmopolitan, 177. 

The new title, 208; ethics of medical societies, 
209 ; medical societies, the winter campaign, 
211. 
A plea for beard, 234; spriritual Munchausenism, 

237 ; Philadelphia Hospital, 237. 
Phases of the tobacco question, 258 : extract 
blodgetti and reverend quacks, 259 ; a word 
private, 260. 
Need of a statue of limitations in our public in- 
stitutions, 291 ; epistolary coincidence, 293. 
Tendencies of therapeautics, 320; violation of 

ethics, 322. 
Compliments of the season, 346 ; hygiene of the 
sewing machine, 347 ; reports of medical so- 
cieties, 348. 
American surgery and French appreciation 375 ; 
medical societies, 376 ; much ado about noth- 
ing, 376. 
Facts vs. figures, 404 ; poisoning, 405 ; medical 

society of New Jersey, 405. 
Coroner's law, 434. 
Hinc ill^ lachrymas, 460 ; international uniform 

for army physicians and surgeons, 462. 
The bpard question, 488 ; medical society of State 

of New York, 491. 
Mental hygiene and public education, 515 ; poetry 

of the skull, 516. 
Mental hygiene and public education, 544; John 
W. Francis, M. D. — obituary notice, 547; the 
second degree, 648. 
Mental hygiene and public education, 571. 
American medical association, 600. 
Impossibility of acclimating races, 623 ; necessity 
for permanent secretary of American medical 
association, 624. 
Has death ever been produced by inhalation of 
sulphuric ether? 656. 



Inter-sessional medical teaching, 688 ; need of a 
public medical library in Philadelphia, 690; 
drug inspectors, 691. 

Close of another volume, 705 ; professsional care- 
lessness, 705 ; sensible charge to jury in case of 
mal-practice, 707; medical society of N. J., 708. 
Education, medical, 436. 
Elbow-joint; syphilitic affection of, 647; exsection 

of, 650. 
Emphysema, 10. 

England, medical education in, 97. 
Entomological pins vs. metallic and other sutures, 

244, 348. 
Entropion, improved method of operating for, 306. 
Epilepsy ; tracheotomy in, 14 ; a consequence of 

tobacco smoking, 212 ; traumatic, 281 ; trephi- 
ning in, 338 ; state of vessels of brain in, 379, 

459; oxide of zinc in, 504. 
Epitaph, a dropsical, 212. 
Epulis, malignant, 204. 
Ergot ; its natural history and uses as a therapeutic 

agent, 415 ; in blenorrhagia, 465. 
Erysipelas, traumatic, 230 ; idopathic, 506. 
Esophagus, stricture of, 202. 
Ether patent, the, 406, 436. 
Examination in central high school, 601. 
Exostosis; on thumb, 431; on big toe — operation, 

476 ; on finger — removal, 591. 
Eye-lids, granular, 306. 
Eye; disease of, [see also '^cataract'" ^ Hens'' ^ and Wills 

Hospital reports,) extensive adhesion between ball 

and lids — operation, 84 ; hydrophthalmia, 94 ; 

summary of cases treated at Wills Hospital, 395, 

396 ; of iris and choroid, 640, 073. 

Fecundity, 629. 

Fees ; for post mortem examinations, 102 ; physi- 
cians, 212. 
Female medical education, 627. 
Femur; fracture of, 11; dislocation of, with com- 
plications, 68 ; specimens of, 206 ; reduction of 
dislocation by Reid's method, with remarks, 453 ; 
fractures of, treatment by simple extension, 539 ; 
dislocation reduced by Reid's method, 583. 

Fever; typhoid and remittent, 32; typhoid, 199, 
201, 233 — with miliary tubercles and efi"usion in 
chest, 206 ; puerperal treated with verat. viride 
and opium, 311 ; eruptive among Chinese, 455 ; 
scarlet, 457 ; typhoid, obscure case, 476. 

Fish, climbing, 631. 

Fistula, anal, 113; in perineo, &c., 589, 684. 

Foetus ; maternal impressions on, 267, 349 ; and 
foetal membranes, discoloration of, 294, 378 ; ex- 
pulsion of, in membranes, 493. 

Food and drinks in Paris, 380. 

Foot, amputation of, 368. 

Fractures; of femur, 11,206; specimens of, 232; 
treatment of, by starched bandage, 233; un-uni- 
ted, successfully treated by Dr. H. H, Smith's 
apparatus, 616 ; intra-uterine, 635; patella, 682. 

France, association of physicians of, 239. 

Freckles, of pregnancy, treatment of, 296. 

Frostbite, severe case of, 618. 

Gall stones discharged per i^ectum, 255. 

Garibaldian medical orders, 379. 

Gas leakage, 126. 

Gastritis, acute idiopathic, 256 ; chronic, 506. 



VI 



INDEX. 



German liospital, the, 709. 
Gingivitis, expulsive, 156. 

Glands, lymphatic, of axilla and thorax, enlarge- 
ment of — extirpation, 310. 
Glasgow, medical matters in, 20. 
Gleet, iodide of potassium in, 617. 
Glycerine, 653. 

Gonorrhea, chlorate of potassa in, 459. 
Gulf stream, the, 710. 
Gunpowder, white, 629. 
Gunshot wounds of hand, 429. 
Gymnastic exercises, abuse of, 200, 335. 

Hfematemesis with chronic dyspepsia, 140. 

Hiemoptysis, 36; frightful case of, 519. 

Hair, sudden whitening of, 659. 

Hanging ; death from, singular appearance of corpse, 
244 ; and strangulation, death by, 245, 302. 

Hare lip, operation, 480. 

Head, injuries to, (3 cases,) 59. 

Headache, congestive, 536. 

Heart ; valvular disease of, 87, 197, 205 ; endocar- 
ditis, 196; hypertrophy with valvular disease — 
abuse of gymnastic exercises, 200, 335; disease 
of, 399 ; clot in diptheria, report on, 399 ; with 
sub-acute rheumatism, 506; hypertrophy with 
fatty degeneracy and valvular disease, 507. 

Hemiplegia, 249. 

Hepatitis, 199. 

Hernia; operation for radical cure of, 144, 166, 
226 ; reduction of, by inverting the patient, 184; 
652; strangulated, new suggestion for relief of, 
234; non-descent of right testicle, 507. 

Hip-joint ; injury of, 60 ; affections of, as a conse- 
quence of uterine disease, 294. 

Hippopotamus, I'esearches on circulation, 150. 

Holmes, currents and counter-currents, 261. 

Homoeopathy, 156. 

Hospital ; a Neapolitan, 152, 381 ; a village, 185 ; 
a special, 349 ; Rainsford island, 602. 

Hospital Pkacttce — Illustrations ov — 
Pennsylvania Hospital. 

Acute phthipis, 8 ; subcutaneous injections, 9 ; 
empyema, 10. 

Aneurism of aorta, 35 ; neuralgia, subcutaneous 
injections in, 35 ; hsemotysis, 36. 

Chronic pleurisy, etc., 58. 

Septicaemia following rheumatism, 86. 

Pelirium tremens, 112. 

Physiognomy of disease, 139; emphysema of 
lungs, 139; hssematemesis and chronic dysnen- 
sia, 140. ^ ^ ^ 

Pneumonia, complicated with tuberculosis, 165. 

Cases of disease of heart, 196, 197. 

Aneurism of aorta, 394. 

Injury to hand from discharge of pistol through 
the palm, 429; conservative surgery, 429; in- 
jury from bursting of gun, 429; amputation at 
the wrist, 429; congenital phymosis — opera- 
tion after Ricord, 430. 

Five cases of scurvy, 446; amputation above the 
wrist— hemorrhage from the radial artery- 
ligature of the brachial, 447. 

Severe bronchitis, 475; obscure case of typhoid 
fever, 476; exostosis of terminal phalanx of 
big toe, operation, 476 ; inverted toe nail, ope- i 



ration, 477; phymosis, operation, 477; stric- 
ture of the urethra, 478 ; scurvy, 478. 

Idiopathic erysipelas of the face, 506 ; heari dis- 
ease, with subacute rheumatism, 506 ; cardiac 
hypertrophy with fatty degeneration and val- 
vular disease, 507 ; hernia, 507. 

Aneurism, 533 ; hydrocele, tapping, remarks, 
534. 

Pleurisy, clinical relation to phthisis, 561 ; frac- 
ture of condyles of humerus, 562 ; novel plastic 
operation, 563. 

Case of obstinate vomiting, treatment, 588 ; wound 
of scalp, 588 ; fistula in perineo involving ure- 
thra and scrotum, abscess above pubes, 589; 
injury near shoulder joint by fall, 589. 

Chronic rheumatism, disease of heart, 617. 

Severe frost bite, 618. 

Albuminuria, 642 ; aneurism of aorta, 643 ; am- 
putation of thigh for un-united fracture of 
femur and anchylosis of knee-joint, remarks on 
pathology of the disease, 644 ; stricture of ure- 
thra, 646 ; chronic disease of ankle joint, 646 ; 
staphyloma of cornea, 647. 

Fracture of patella — three cases, 682. 



PMladelpM 

Venereal vegetations, (with cut,) 10 ; opening of 
clinics at, 75. 

Enormous enlargement of liver in a young girl, 
166 ; new operation for radical cure of hernia, 
(with cuts,) 166; false joint of humerus, 167. 

Syphilis, 197; anchylosis of elbow joint, 199 ; 
typhoid fever, 199; hepatitis, 199. 

Three cases of paralysis, 249 ; epileptiform con- 
vulsions with paraplegia, 249. 

Chorea, 278, 

Secondary syphilis, 304. 

Chronic dysentery, 335. 

Tertiary syphilis, 367 ; amputation through foot, 
368 ; stricture of rectum, 368. 

Pleurisy with hepatic complication, 448 ; exces- 
sive diuresis, 449. 

Diuresis following sun stroke, 504 ; epilepsy, re- 
lief by use of oxide of zinc, 504 ; aneurism — re- 
curring pneumonia, 505 ; chronic gastritis, 506; 
cephalalgia from congestion, 506. 

Paralysis agitans from cerebral disease, remarks, 
534 ; acute tubercular — infiltration of the 
lungs, 535 ; asthma, 636 ; congestive head- 
ache, 536. 

Asthma from cardiac disease and emphysema, 
563-4 : morbid specimens— meningitis, 564 ; 
paralysis agitans, 564. 

Wills Hospital, [Philadelphia) 

Summary of cataract cases for Oct. and Nov., 
1860, lenticular cataract, 279; false cataract, 
279 ; extraction of capsule from both eyes by 
Wilde's canula forceps, 280. 

Summary of cases of diseased eyelids treated 
during Oct. and Nov., 306 ; granular lids, 306; 
entropion, 306. 

Summary of cases during quarterly term ending 
Jan. 1st, 1860, 395. 

Capsulo-lenticular cataract, 430 ; pterygium, 430 ; 
strabismus, 430. 

Lachrymal fistula, 449 ; symblepharon, 450 ; te- 
langiectasis, 450. 



INDEX. 



vu 



Four cases of cataract, operations by solution and 
extraction, 479 ; artificial pupil, 480. 

Capsulo-lenticular cataract, 508 ; division through 
the sclerotica — posterior operation, 508. 

Strabismus, operations, 565 ; tumor of lower eye- 
lid, 566. 

Episcopal Hospital, [Philadelphia) — - 
Femur, fracture of, (new apparatus,) 11 ; three 
cases injury to head, 59. 

Howard Hospital, [Philadelphia) — 
Stone in the bladder, 37 ; syphilitic condyloma at 
verge of anus, 38 ; syphilitic hydrosarcocele, 
38. 

University of Pennsylvania — 

Incipient softening of brain, 39 ; phthisis in an 
infant, 39. 

Effects of tobacco, 60. 

"Valvular disease of the heart, 87. 

Phthisis and rheumatism of the shoulders, 141. 

Sequelae of scarlatina — paralysis, 168 ; pleuro- 
pneumonia in a^oy, 168. 

Intercostal rheumatism, 200 ; hypertrophy of 
heart, with valvular disease — abuse of gym- 
nastic exercises, 200; latent typhoid fever, 201 ; 
phthisis — value of topical medication, 201 ; 
chronic bronchial affection, 202 ; stricture of 
oesophagus, 202 ; rheumatic affection of shoul- 
der, 203 ; dyspepsia, 203. 

Epileptiform convulsions in a boy, 227 ; thoracic 
disease, results of pleurisy, doubtful physical 
signs, 228 ; dyspepsia, 229 ; aneurism of aorta, 
229; tape- worm, 229; chronic bronchitis — 
emphysema, 230. 

Chronic bronchial affection — interesting physical 
signs, 251 ; pulmonary tuberculosis — emphy- 
sema, 251-2. 

Vascular tumors — 7 cases, 307. 

Valvular disease of heart, 335 ; hysteria from 
dysmenorrhgea, 335 ; skin disease, 335 ; cases 
of cancer, 336, 

Acute renal dropsy, 396 ; albuminuria, 396 ; 
chorea, 396 ; phthisis with emphysema, 397 ; 
phthisis with absence of tubercles, 397 ; chro- 
nic capillary bronchitis, 397 ; tape-worm, 398 ; 
chronic laryngitis with aphonia, 398. 

Paralysis after diphtheria, 431. 

Jefferson Medical College — 
Injury of the hip joint, 60 ; cancer of the breast, 

60 ; stone in the bladder — lithotomy, 61 ; vari- 
cose ulcer, 61. 
Cataract, 88 ; club-foot, 88 ; mole, 88. 
Enlarged tonsils, 112; anal fistule, 113; ranula, 

113; wry neck, 113; rhinoplasty, 113. 
Aneurism of aorta, 142. 
Popliteal aneurism, 169 ; Pott's disease of spine, 

169. 
Injury to brain, 230 ; erysipelas after a surgical 

operation, 230. 
Aneurism, 280. 
Onychia maligna, 309 : enlargement of lymphatic 

glands of thorax and axilla — extirpation, 310; 

remarks on administration of chloroform, 311. 
Cancer of breast — 18 operations in three years, 

34 tumors removed, 337. 



Exostosis on the thumb, 431 ; soft tumor in the 
velum pendulum palati, 431 ; medullary can- 
cer of the antrum, with removal of the tumor 
and the superior maxillary bone with adjacent 
parts, 432. 

Deformity of face from abuse of mercury, 450 ; 
deformity of lower extremities and operation by 
division of the tendons of the pectinei muscles, 
451 ; encephaloid cancer of mammary gland, 
operation, 451 ; epithelial cancer of lip, remo- 
val, 452. 

Fatty tumor of jaw, removal, 480 ; operation for 
hare-lip, 480 ; hydrocephalus, tapping, with 
remarks, 481. 

Plastic operation for formation of a new nose, 
509 ; stricture of urethra cured by division — 
circocele in same patient, operation for radical 
cure, remarks, 566 ; cases of cancer, 590-91 ; 
exostosis of middle phalanx of a finger, 591 ; 
Pott's disease of spine, 592. 

Club-foot, tenotomy, division of soleus, 618 ; cys- 
tic tumor on neck, removal, 619 ; varicose en- 
largement of corpus pampiniforme, with stric- 
ture of urethra, 619; scirrhus cancer of breast, 
removal, 619. 

Syphilitic affection of elbow-joint, 647 ; white 
swelling of knee-joint, 647. 

Pott's disease in an infant, 683 ; hydrocele caused 

by strain, 683; hydrocele of cord, 684; fistula 

in perineum, 684 ; cutaneous eruption on valva, 

685; removal of calculus from urethra, 685; 

removal of tumor from parotid region, 685 ; 

a neevus occupying lip and inside of cheek, 

686. 

*, 

New York Hospitals and Clinics — 

Mercury in primary syphilis, 170 : leprosy, sy- 
philis, and struma, 170; idiopathic tetanus, 
170; post-mortem after cesarean section, 170; 
case of pelvic presentation, 171. 

Abscess of broad ligament, secondary symptoms, 
203 ; submucus fibrous tumor in the uterus — 
persistent menorrhagia, 203 ; syphilitic rupia, 
204 ; cancer of penis amputation by the ecra- 
seur, 204; malignant epulis, 204; subclavian 
aneurism — ligature, 204, 

Diagnosis of pregnancy, 253 ; vicarious menstrua- 
tion, 253; paralysis, 253. 

Traumatic epilepsy, 281. 

Puerperal fever treated with verat. viride and 
opium — recovery — -remarks, 311. 

Trephining in epilepsy, 338; puerperal fever — 
p. m, appearances, 338. 

Brooklyn Med. and Surg. Institute — 
Injury to knee joint — singular deformity — total 
exsection of knee-joint — recovery with a useful 
limb, 648; exsection of elbow-joint, 650. 

Hospital of Medical Missionary Society, Canton, 
China — 
New hospital, 568; vaccination, 568; general 
diseases, 568; caries of upper jawbone, 568: 
dropsy, 568; tumor, 568; fracture of spine 
and ribs, 569; perineal section, 569; neural- 
gia, operation, 569; amputation of thumb, 569; 
do, of breast, 669; stone in urethra, 570; uri- 
nary calculus, 570; dislocation of hip-joint, 
570. 



Vlll 



INDEX. 



Hospitals, origin of, 111. 

Humerus; false joint of, 167; fracture of anatomi- 
cal neck, 340 ; reduction of luxations of head of, 
bv manipulation, 197; fracture of the condyles, 
502. 

Hunter, John, at home, 26G. 

Hydrocele ; tapping, with remarks, 534, 683 ; of 
cord, 684. 

Hydrocephalus, tapping at lambdoidal suture, 481. 

Hydrophobia, 101, 206 ; after an incubation of four- 
teen months, 522 ; diagnosis of, 687. 

Hydro-electric chain battery, improvement on, 428. 

Hydrophthalmia, operation for, 94. 

Hysteria from dysmenorrhea, 335. 

Idiots, education of, 345. 

Imbecility, statistics of, 130. 

Indians, practice of medicine among, 266, 709. 

Inflammation prevented by pressure, 234. 

Ingesta and egesta, amount of, 128, 

Inhalers, Luther's, 629. 

Injections, subcutaneous, 9. 

Insane ; pauper of England, 152 : lectures to, 184 ; 
deprivations of, for sake of society, 408 ; in Phila. 
Almshouse, 464; hematic swelling of ears of, 621, 

Insanity, statistics of, in Belgium, 213. 

Introductories in Philadelphia, 46 ; in New York, 99. 

Intussusception, fatal, 277. 

Iodine, history of, 320. 

Iowa, health of, 158. 

Iris and choroid, diseases of, 640, 673, 697. 

Iron ; in diseases of skin, 66 ; stearate of, 128 ; a bar 
of, through the head, 183: in poisoning by arse- 
nic, 709. 

Japan, polypharmacy of, 156. 
Jaundice, epidemic, 39. 
Jaw " locked open!" 182. 
Jessamine, poisoning by, 366. 
Judge, sensible charge of a, 707. 

Kidneyp, degeneration of, 319. 

Knee-joint ; intra-uterine dislocation of, 143 ; white 

swelling of, 647; exsection of, recovery with 

useful limb, 648. 

Lancing gums, 599, 

Laryngitis, chronic, with aphonia, tuberculosis, 898. 
Laryngoscope, 151. 
Leg, fracture of both bones of, 11. 
Lens, crystaline, and its diseases, 27, 53, 79, 187, 
215, 411. > > , > , 

Leprosy, syphilis and struma, 170. 

Leroy d' EtioUes, death of, 238. 

Life-saving apparatus, 711. 

Life, duration of, 77. 

Ligature of brachial artery, 447, 591. 

Light, magnetic, 240. 

Literary curiosity, 155. 

Literature, American medical, status of, 16. 

Lithotomy, 61. 

Liver, fatty, and valvular disease of heart, 205. 

London; medical matters in, 124, 179; provision 
supplies for, 264. 

Love and the doctors, 265. 

Lucifer matches, death of an infant from, 522. 

Lungs; emphysema of, 139; intra-uterine emphy- 
sema, 494 ; acute tubercular infiltration, 535, 



Madmen, literary, 153. 

Malpractice, 379. 

Mammas, inflamed, belladonna in, 137. 

Manganese, 464, 

Mania, puerperal, verat. viride, in (discussion) . 

12, 481, 510. 
Medical College of Alabama, 712. 
Medical education. Dr. H. Miller on, 295, 
Medical profession in England, present condition 

of, 20. 

Medical Societies — 
Philadelphia County — 

Opium as a therapeutic agent, 61, 88, 113. 

Morbid specimens — diphtheria, 282 ; ruptured 
uterus, 283 ; ascaris lumbricoides entrapped, 
284; doctrine of debility and treatment of 
disease by stimulants, 283, 313 (discussion.) 

Heart disease, 399 ; heart clot in diphtheria — 
report of committee, 399 ; differential diagnosis 
of ovarian tumors, 400. 

Peuperal insanity, 481, 510, (discussion.) 

Academy of 3£edicine, (N'. Y.) — 
Annual meeting — address of Dr. Watson, 172, 
Annual reports, 287 ; writing prescriptions — ■ 

weights and measures, 288. 
Internal application of ointments, 341 ; catalogue 
of museum of N. Y. Hospital, 341 ; idiopathic 
tetanus — cannabis Indica, 341 ; curious case of 
cerebral trouble in a child, 342 ; tetanus in 
children from premature ossification of skull, 
342; extensive tubercular deposit in a child, 
342 ; discussion on business matters, 369. 

Pathological Society^ {N. Y.) — 
Pericarditis — abscess communicating with the 
pleura, 204 ; fatty liver — disease and perfora- 
tion of aortic valves, 205 ; fracture of femur, 
specimens, 206 ; typhoid fever, miliary tuber- 
cles, effusion in the chest, 206 ; white swelling 
— resection of condyles, 206 ; tumors of choroid 
— extensive disease of eye — extirpation, 231 ; 
mulberry calculus, 231 ; disease of aorta — rup- 
ture — eftusion of blood into pericardium, 231 ; 
purpura — cerebral hemorrhage — apoplexy, 232; 
specimens of fractures, 232 ; fibrous tumor of 
uterus, 254 ; constriction of colon — death, 254 ; 
gall-stone discharged per rectum, 255 ; clot 
on dura-mater from injury, 255; premature 
birth — foetus, 255 ; tumor in axilla, 255 ; acute 
idiopathic gastritis, 256 ; degeneration of spleen 
and kidneys, 319; cancer of mammary gland — 
cases — discussion, 339 ; fracture of anat. neck' 
of humerus, 340. 

State of New Jersey — 
President's address, 456 ; report of standing com- 
mittee, 456 ; diphtheria, 456 ; scarlet fever, 457 ; 
rise and progress of malarious disease, 457 ; 
medical organization, 457 ; on mind and nervous 
system, &c., 457 ; miscellaneous business, 458 ; 
officers and delegates, 459. 

State of New York — 
President's address, 536 ; delegates from Connec- 
ticut, 538 ; commission of lunacy, 538 ; placenta 
at twin birth, 538 ; mercury in acute pericarditis, 



INDEX. 



IX 



538 ; suspended animation — resuscitation, by 
M. Hall's method, 538 ; treatment of frac- 
tures of femur by simple extension, 539; medi- 
cal education 541 : miscellaneous business, 541 ; 
secretary's report, 541 ; memoir of Dr. Burton, 
542; papers &c., presented, 542; reports of 
committees, 543, officers and delegates, 543 ; 
papers read and scientific discussions, 544. 

Albany County, (iV. Y.) — 

Hydrophobia, 206 ; peculiar pulmonary affection, 
207; tetanus, 207 ; officers for 1860-61, 207. 

Alcohol as a remedial agent, 343 ; tubercular 
meningitis, 453 ; reduction of dislocation of 
femur by Reid's method, with observations, 
453 ; delirium tremens, 592. 

Rheumatism followed by diphtheria — fatal termi- 
nation by inflammation, and perforation of 
ilium, 703 ; polypus uteri with pregnancy, 704; 
generation of animal heat, 705. 

Lancaster, [Pennsylvania.) — 
Veratrum viride in puerperal mania, 12.. 

Medical Science, cosmopolitan, 695. 

Meigs, Professor C D., presentation of portrait to, 

664. 
Meningitis, tubercular, 453; morbid specimens, 564. 
Mental hygiene, 515, 544, 571. 
Menstruation, vicarious, 253. 
Mercury ; volatility of, 183 ; deformity of face from 

abuse of, 450, 
Metal, new fusible, 609. 

Metallic ligature for cure of varicose veins, 583. 
Microscope v. corn doctors, 268. 
Microscopic examination of sputum, diagnostic 

value of, 557. 
Midwife committed for manslaughter, 494. 
Milk ; secreted by tumors in axilla, 120 ; blue, 154 ; 

examination of, 184. 
Mole, congenital, 88. 
Monomania, curious case of, 23. 
Morbid specimen, 535. 
Morocco, medicine in, 379. 
Mortality, infantile, in London, 183. 
Mortuary record of Sussex co., Del., 32. 
Mullein in chronic bronchitis, 1G3. 

Nail, ingrowing, Gilman's treatment of, 34. 

Nails, growth of, 49. 

Natural history, strange fact in, 241. 

Nervous system; physiology of, 217; and mind in 
relation to disease, 457. 

Neuralgia; subcutaneous injections in, 35 ; stramo- 
nium in, 143 ; sciatic, clinical remarks on, 579, 

New Orleans school of medicine, 712. 

Nitrogen, absorption of, by plants, 131. 

Nostrums, increase of sale of, 606. 

Obituary notices of Drs. A. F. Holmes, 104; C. H, 
Martin, 105 ; Leroy d'Etiolles, 238 ; D, D. Owen, 
241; N. Bruce, 324; C, Bucher, 438; John 
Phillips, 438; Casper Van Wie Burton, 542; 
John Wakefield Francis, 547. 

Ointments, internal application of, 341. 

Onychia maligna, 309. 

Ophthalmia, formula of collyria for, with glycerine 
as an excipient, 380. 



Ophthalmic school, N. Y., 604, 

Ophthalmascopy, present state of, 6, 30, {cuts.) 

Opium ; as a therapeutic agent, 61, 88, 113 ; alleged 
poisoning by, 597 ; what becomes of it, 625. 

Ovaries ; cystic tumors of, 332, 362, 425 ; differen- 
tial diagnosis of tumors of, 401. 

Ovariotomy, who first performed the operation, 
686. -* 

Oxy-hydrogen retort, and steam superheater, 48. 

Ozoena, treatment of, 154. 

Paralysis; general hypocondriacal conceptions a pre- 
curser of, 94; paraplegia, 249; hemigplegia, 
249 ; cases of, 253 ; partial, after diphtheria, 
431 ; agitans from cerebal disease, 534 ; from 
disturbance of nervous system, 564, 

Paraplegia, 249, 250. 

Paris ; medical matters in, 150 ; food and drink in, 
380. 

Patella, fracture of, 682. 

Pelvic presentation, case of, 171. 

Penis, cancer of, amputation by ecraseur, 204. 

Pericarditis, with abscess com. with pleura, 204. 

Phthisis, 252 ; acute, 8, 252 ; in an infant, 39 ; and 
rheumatism of shoulders, 141 ; affection of lar- 
ynx, topical medication, 201 ; new treatment of, 
238 ; with emphysema, 251 ; do., with absence 
of physical signs of tubercle, 397 ; treatment of, 
604. 

Phymosis ; congenital, 430; operationby rupture of 
mucous membrane, 477. 

Physical signs ; doubtful, 228 ; absence of in case 
of phthisis, 397. 

Physician, the true, address of Dr. Watson, 157, 
172. 

Physician to the Queen of Great Britain, 712, 

Physiological opinions of the 16th century, 630. 

Physiologists, a fact for, 380. 

Physiology, experimental, 40. 

Piarrh9emia, 14. 

Plastic operation ; for new nose, 509 ; novel, on 
the face to restore parts destroyed from abuse 
of mercury, 563. 

Pleurisy ; chronic, with complications, 58 ; thoracic 
disease, result of, 228 ; with hepatic complica- 
tion, 448 ; clinical relation to phthisis, 561. 

Pleuro-pneumonia in a boy, 168. 

Pneumonia; comp. with tuberculosis, 185; recurr- 
ing, with remarks, 505 ; clinical remarks, 637. 

Poisoned ring, 152 ; paper-hangings, 692. 

Poisoning ; case of supposed, 100 ; by arsenic, 103 ; 
by atropine, 110; by opium and strychnia, 175; 
by strychnia, 227 ; by jessamine, 366 ; by strych- 
nia, chloroform in, 687. 

Polypus ; raspberry in external ear, 162 ; uteri with 
pregnancy, 704. 

Population, density of, 465. 

Potash, preparation of antimoniate of, 103 ; chlo- 
rate of, 621, 651. 

Pregnancy ; diagnosis of, 253 ; extra-uterine, 380 ; 
placental, 381. 

Premature labor, gastric pain, severe flooding, 
eclampsia, apoplexy, rapid recovery, etc., 700. 

Prescription, writing, 288. 

Prolificity, influence of climate on, 694. 

Prussia, medical statistics of, 193. 

Puerperal fever, 338 ; insanity, (discussion,) 481, 
510. 



X 



INDEX. 



Pulmonary nfFcction, peculiar, 207 ; tuberculosis, 
vnlue of pulse as diagnostic sign of, 297. 

Pulse, the, its value as a diagnostic sign of pul 
monary tuberculosis, with cases, 297 ; chronal 
law of, G20. 

Purpurea, cerebral hemorrhage — apoplexy, 232. 

Quack; adveytisements, 130, 259 ; doctor, examina- 
tion of, 6G8. 
Quackery, infamous, 661. 
Quacks, "reverend," 2-59. 

Ranula, 113. 

Rape, committed during magnetic sleep, 50. 

Rattlesnake, on the poison of, 92. 

Rectum ; stricture of, from removal of hemorrhoids 

Reminiscences of the college of physicians and sur- 
geons of New York, and its founder, Dr. Samuel 
Bard, 710. 
by means of ecraseur, 256; stricture of, 368. 

Respiration, artificial, not to be used in resuscita- 
tion of still-born infants, 377. 

Reviews and Book Notices. 

Ashton — Rectum and anus, &c., 15. 

Druitt — Surgery, 15. 

Meigs, J. A. — On form of occiput in man, 120. 

Hilles — Pocket anatomist, 121. 

Churchill, (edited by Condie) — Midwifery, 144. 

Garratt — Electro-Physiology and electro-thera- 
peutics, 177. 

Morel, (edited by Van Buren) — Human histology, 
257. 

Fitzgerald — Vocal music in Public Schools, 257. 

Hodge — Diseases peculiar to woman, 290. 

Leared — On imperfect digestion, 373. 

Regnault — Elements of chemistry, 375. 

Knapp — Primary Pathology and laws of epidemics, 
4«3. 

Leidy — Human anatomy, 433. 

Bodenhamer — Rectum and anus, 487. 

Choate — Report of State lunatic asylum, Taunton, 
Mass., 593. 

Brown-Sequard — Physiology and pathology of 
central nervous system, 622. 

Paralysis of lower extremities, 622. 

Lyons — Handbook of practice, 623. 

Gross — Medical biography, 654. 

Transactions of American Medical association, 
vol. 13, 654. 

Slade— On diphtheria, 655. 

Moore — Valedictory address, 688. 
Rheumatism; intercostal, 200; of shoulder, 203; 

acute articular, clinical remarks, 581 ; chronic, 

with disease of heirt, 617; and diphtheria, fatal 

termination by inflammation and perforation of 

ilium, 703. 
Rhinoplasty, 113. 
Ring, a poisoned, 152. 
Rupia, syphilitic, 204. 

Sanitary; Congress, 4G5 ; new association, 576, 625. 
Sambuci, observations on medical use of, 641. 
S3arlatin?k,; sequclre of, paralysis, 168; digitalis in, 

262, 324; Sydenham on, 350. 
Science at Ibottom of sea, 378. 
Scurvy, cases of, 440, 478. 
Septicaemia, following rheumatism, 86. 



Sewage, disinfection of, 151. 

Sewing machine, hygiene of, 347. 

Sex of child, alleged discovery of, by counting pul- 
sations of the foetal heart, 144. 

Silkworm, on alianthus tree, 464. 

Skin diseases; iron in, 66; syphilitic rupia, 204; 
malignant epulis, 204; chronic, 335; lecture on, 
667. 

Small pox, prevention of pitting by, 652. 

Snake bites, 632. 

Societies, medical, in New York, 180. 

Spain, medical matters in, 574, 627, 693. 

Spasms, intermittent, albuminuria, 149. 

Sphygmograph, the, 408, 

Spider bite, supposed, severe symptoms, 111. 

Spinal cord and investing membranes, contribution 
to pathology of, 701. 

Spine; caries of, with pleurisy, &c., 58; Pott's dis- 
ease of, 169, 592; in an infant, 683. 

Spleen, degeneration of, 319. 

Sponge, method of bleaching, 663. 

Sputa, importance of microscopic examination of, 
557. 

Statistics, immigrant, 626. 

Statistics of females, 710. 

Sternum, fracture of, etc., 12. 

Still-born infants, artificial respiration not to be 
used in, 377. 

Stimulant, beverages, 634- 

Stimulants, treatment of disease by, 284, 313. 

Strabismus, operations, 565. 

Stramonium in neuralgia, 143. 

Strychnia ; tannin as an antidote to, 20 ; none in 
whisky, 50; in paralysis of typhoid fever, 142; 
poisoning by, 227, 521 ; chloroform in poisoning 
by, 687. 

Stung to death, 152. 

Subclavian, ligature of, 204. 

Sugar, production of, during abstinence, etc., in 
animals, 345. 

Surgery, new positions in, 687. 

Surgical case, remarkable, 661. 

Sydenham society, 631. 

Syncope and asphyxia, in new-born children, method 
of treating, 575. 

Syphylitic condyloma, 38 ; hydrosarcocele, 38 ; sore 
throat, 86 : rupia, 204. 

Syphilis, 197; primary, mercury in, 170; secon- 
dary, 304 ; tertiary, 367 ; in the 15th century, 
492. 

Syria, health of, 126. 

Tsenia, new remedy, 464. 

Tannin as an antidote to strychnia and narcotic 
irritants, 20. 

Tape-worm, 229, 398; aromatic sulphuric acid in 
treatment of, 40. 

Telangiectasis or vascular tumors, 307. 

Tetanus, 207 ; idiopathic, failure of quinine, good 
effects of stimulation, 170 ; in a child, from cal- 
culus in ureter, 181 ; idiopathic, cannabis Indica, 
341; in children from premature ossification of 

: skull, 342; woorara in, 372; cases, 460. 

Therapeutics, tendencies, 320. 

Tobacco, effects of, 60; phases of question, 258. 

Toe'uail, inverted, operation, 477. 

Tonsils, enlarged, operation for, 112. 

Tracheotomy in epilepsy, 14. 



ORIGINAL CONTEIBUTORS. 



XI 



Treatment, sustaining and stimulating in France, 
154. 

Tubercular, deposit in a child, 342 ; meningitis, 
453. 

Tubercle, pathology of, 604. 

Tuberculosis; abdominal, 176: pulmonary, 251. 

Tumor; fibrous, of uterus — persistent menorrhagia, 
203 ; in axilla, 255 ; vascular, 307 ; cystic of 
ovaries, 332, 362, 425, 471, 500, 508, 553 ; ova- 
rian, differential diagnosis of, 400; in velum pen- 
dulum palati — removal, 431 ; of jaw — removal, 
480 ; abdominal, remarks on diagnosis, case of 
omental, 494; cystic on back of neck, 619; re- 
moval of from parotid region, 685 ; omental, 
694. 

Turpentine, oil of, toleration of large quantities of, 
711. 

Ulcer, varicose, 61. 

Umbilical cord, shortness and compression of, 372. 

Un-united fncture; successfully treated by Dr. H. 

H, Smith's aparatus, 615; of femur, 644. 
Urethra, stricture of, 478 : cured by division, 566 ; 

stricture of, with enlargement of corpus pampini- 

forme, 619 ; organic stricture of, 646. 
Urinary deposits, abnormal, 221 ; (with cuts,) 271, 

(with cuts,) 359, 386. 
Uteri, OS, ulceration of, treatment, 681. 
Uterine disease as a cause of hip-joint disease, 294 ; 

hydatids, 349. 



Uterus ; fibrous tumor of, 254; ruptured, 283; uni- 
corn, 605. 

Vaccinatioi^, long incubation, 577. 

Vagina, complete absence of, 359. 

Van Bibron's antidote for snake bite, 45. 

Varicose veins, sub-cutaneous application of metal- 
lic ligatures in, 159. 

Variola, influence of the poison of, 520. 

Varioloid, time of appearance and disappearance, 
295. 

Venereal vegetations, 10. 

Ventilation of rail cars, 267. 

Veratrum viride ; in puerperal mania, 12; its phy- 
siological and therapeutical action, 107. 

Vital induction, (animal magnetism,) note on, 406. 

Vomiting; obstinate case of, 588; nitrate of silver 
in, 653. 

Vulva, cutaneous eruption on, 685. 

Warts, venereal, 10. 

Weights and measures, 288. 

White swelling, 206. 

Woorara; in convulsive affections, 345; in tetanus, 
372. 

Wound, extensive, 263; of scalp, 588. 

Wounds; dissecting, 25; reparation of during ex- 
istence of syphilis, 345. 



ORiamAL CONTRIBUTORS TO THIS VOLUME. 



Agnew, D. H., anatomy in its relations to medicine 

and surgery, 82, 132, 219, 327, 439, 470, 

651, 677; clinics of, 166, 197, 304, 367. 
Albxandeb, C, treatment of ulceration of os 

uteri, 681. 
Aeink, Gerard, microscopia of acarus or scabies 

mites, 685. 
AsHUEST, John, note on vital induction, (animal 

magnetism,) 406. 
Ati.ee, J. L., sen., veratrum viride in puerperal 

mania, 12. 
A'si.EE, W. L., case of quadruple birth, 195; on 

diferential diagnosis of ovarian tumors, 400. 
Atkinson, W. B., reports of Philadelphia County 

Medical Society, 61, 88, 113, 282, 313, 399, 

481, 510. 

Barker, B. F., Cesserean section — post-mortem, 
170. 

Baubb, L., clinics of, 648; contributions to patho 
logy of spinal cord and its investing mem- 
branes, 701. 

Blalock, N. G., clinical reports, 60, 88, 112, 142, 
166, 169, 199, 304, 367. 

Bland, D. W., artificial respiration not to be used 
in resuscitation of still-born infants, 377. 

BoiSNOT, J. M., metallic ligatures for cure of va- 
ricose veins, 683. 

BcTLER, S. W., epileptiform convulsions — paraple- 
gia, 249-50. 

Cady, C. E. , on digitalis in scarlatina, 324<. 



Carter, Wm. F., hpdrophobia, 206 ; peculiar pul- 
monary affection, 207. 

Carpenter, H., veratrum viride in puerperal ma- 
nia, 13. 

Chapman, E. N., on ergot, its natural history and 
uses as a therapeutic agent, 415. 

Clark, Alonzo, clinics of, 170 ; pathological speci- 
mens, 204 ; degeneration of spleen and kid- 
neys, 319. 

Clakkson, H M., in-growing toe-nail, 34. 

CoATES, B. H., on opium, 113. 

CoNANT, D. S., specimens of fractures, 232. 

Corse, J. M., disease of heart, 399. 

CoNDiE, D. F., on opium, 115 ; on stimulation, 313. 

Cook, J. L., intermittent spasms, albuminuria, 149, 

DaCosta, J. M., clinics of, 448, 514, 534, 563; 
lecture, 495. 

Daerach, W., on opium, 118; on stimulation, 316. 

Dougherty, A. N., reduction of axillary luxation 
by manipulation, 687. 

DuNLAP, J. B., poisoning by strychnia, recovery, 
227. 

Dutcher, a. p., value of pulse as a diagnostic sign 
of pulmonary tuberculosis, 297 ; cough and 
expectoration as a sign of pulmonary tuber- 
culosis, 557. 

Elliott, Geo. D., clinic of, 171. 
Erdman, W. B., dislocations of femur with compli- 
cations, 68. 



xu 



OEIGINAL CONTRIBUTOES. 



FiNNELL, T. C, disease of aorta, &c., 231 ; purpura 

apoplexy, 232. 
Fountain, E, J., pathology of albuminuria, 613. 
Feter, B. E., clinic reports, 11, 59. 

Gabretson, J. E., radical cure of inguinal hernia, 

opei'ation, 226 ; on chilblain, 436. 
Gerhard, W. W., clinics of, 139, 165, 196, 394, 

446, 475, 506, 633, 561, 588, 617, 642. 
GoBRECHT, W. H., ruptured uterus, 283. 
Goodman, H. E., clinical reports, 279, 430, 449, 

479, 508, 565. 
Griscom, J. H., letter from, 72. 
Gross, S. D., clinics of, 60. 88, 112, 142, 169, 230, 

309, 337, 685. 
Gross, S. W., clinics of, 37, 60. 

Hackley, C. E., improvement on Pulvermasher's 

hydro-electic chain battery, 428. 
Hall, W. H., poisoning by jessamine, 366. 
Hamilton, opium as a therapeutic agent, 61, 81. 
Hartshorne, H., on stimulation, 317. 
Hewson, a., ophthalmic clinics, 299, 306. 
HiNKLE, F., removal of tumor of antrum, 4. 
HoFF, A. H., tetanus, 207. 

Kilmer, W., generation of animal heat, 705. 
King, S. M,, extraordinary case of ascites, 35. 
Knapp, M. L., on disease epidemically and epizoo- 

tically in U. S. in 1860, 135, 193, 275, 300. 
KuECHLER, M., present state of ophthalmoscopy, 6. 

Lehlbach, C. F. J., death by hanging and stran- 
gulation, 245, 302; mental hygiene, 515, 
644, 571. 

Levis, R. J., venereal vegetations, 10; metallic 
■ ligatures in varicose veins, (with cuts,) 159. 

LiPPiNCOTT, Allan, case of intussusception, 277. 

Ludlow, J. L., introductorv address, 75; clinics 
of, 166, 199, 249, 278* 335. 

Marr, W. p., on omental tumors, 694. 

Maull, D. W., mortuary records of Sussex county, 

Delaware, 32. 
*' M. D. Abroad," foreign correspondence, 20, 98, 

124, 150, 518, 574, 627, 693. 
Meigs, J. Forsyth, chronic softening of brain, 1 ; 

clinics of, 8, 35, 68, 86, 112. 
Metcalfe, Prof., mulberry calculus, 231. 
Morris, J. Cheston, physiology of nervous system, 

217. 
Morton, S. M., clinics of, 430, 449, 479, 508, 565. 
Mott, v., on leprosy, syphilis, and struma, 170. 

Notes, tumor of choroid, exterpation, 231. 

Palmer, 0. D,, observations on cystic tumors of 
ovaries, (translations,) 232, 362, 425, 471, 
600, 528, 653. 

Pancoast, Joseph, clinics of, 429, 431, 446, 450, 
476, 480, 507, 509, 534, 562, 566, 588, 
590, 618, 644, 647, 682-3; lectures, 467, 
679. 

Parrish, Ed., therapeutical and pharmaceutical 
remarks on cimicifuga, 531. 

Patzb, a., tannin as an antidote to strychnia and 
narcotic irritants, 20. 

Pepper, W. W., clinics of, 39, 60, 86, 141, 168, 
200, 227, 251. 390, 430; lectures on diph- 
theria, 355, 383. 



Remington, Isaac, on opium, 118. 

Rittenhouse, Samuel R., discoloration of foetus 
and foetal membranes, 294 ; overdoses of 
arsenic — poisoning — good effects of iron, 
709. 

Smith, C. H., singular appearance of corpse after 
death by hanging, 244. 

Smith, F. G., lectures : on albuminuria, 523 ; acute 
articular rheumatism, 581 ; lead cholic, 607 ; 
pneumonia, 637; Skin diseases, 667. 

Smith, H. H., clinics of, 307, 336 ; reduction of 
luxations of humerus by manipulation, 497. 

Staples, G. M., on imperfect development of cra- 
nium in a foetus, 164. 

Swinburne, J., entomology pins v. metallic and 
other sutures, 243 ; cancer of womb, 330'; 
observations on Reid's method of reducing 
dislocations, 453 ; treatment of fractures by 
simple extension, 539; new method of treat- 
ing Barton's fracture, 609 ; polypus uteri 
complicated, with pregnancy, 704. 

Squibb, E. R., writing prescriptions — weights and 
measures, 288. 

Thomas, R. P., clinics of, 11, 59; on opium, 119; 
diphtheria, &c., 282. 

Thompson, D., on spider bite. 111. 

Thompson, J. W., on belladonna in inflamed mam- 
mae, fauces, &c., 137. 

Toner, J. M., on abortion in its medical and moral 
aspects, 443. 

TowNSEND, Howard, rheumatism, followed by diph- 
theria — fatal termination by inflammation 
and perforation of ilium, 703. 

Triplet, W. H., diphtheria in Valley of Virginia, 
616. 

Tryon, J. R., clinical report, 37. 

TuNisoN, P. T., premature labor, gastric pain, 
flooding, eclampsia, apoplexy, etc., 700. 

TuRNBULL, L., lectures on crystaline lens and its 
diseases, 27, 63, 79, 187, 215, 411 ; cases in 
aural surgery, 161 ; the iris and choroid, 
640, 673, 697; medical use of "vinum sam- 
buci," 641. 

Van Buren, clinics of, 281, 338. 

Wagenseller, B. F., dislocation of femur reduced 
by Reid's method, 586. 

Walter, A. S., extensive adhesions between ball of 
eye and eye-lid — operation, 84. 

Walters, Wm., ununited fracture successfully 
treated, 615. 

Watson, J., extract from anniversary address, 361. 

Wilson, B. H., iodide of potassium in gleet, 617. 

Wilson, H., mullein in chronic bronchitis, 163, 

Wilson, J. H., reduction of axillary luxation, 631. 

WiLLARD, S. D., report of Albany County N. Y. 
Medical Society, 206, 343, 453, 592. 

Wood, J, R., clinics of, 170; pathological speci- 
mens, 206. 

WoODHULL, A. W., cases of abnormal urinary de- 
posits, (with cuts,) 221, 271, 359, 386. 

Woodward, B., concussion of brain, and injury to 
pneumogastric nerve, 57 ; on veratrum viride, 
107. 

Woodward, J. J., clinical reports by, 307, 336; 
report on heart clot in diphtheria, 399. 



THE 



MEDICAL AND SURGICAL REPOxHTER. 



WHOLE SERIES, 
NO. 207. 



} PHILADELPHIA, OCTOBER 6, 1860. 



NEW SERIES 
VOL. V. NO. 1. 



ORIGINAL DEPARTMENT, 

LECTURES. 

Chronic Softening^ of the Brain : A Clinical 
Lecture delivered at the Pennsylvania 
Hospital. 

By J. Forsyth Meigs, M. D., 

One of the Attending Physicians. 
[Reported for the Medical and Surgical Reporter.] 

Gentlemen : It is by studying out carefully a 
single one of those difficult and obscure cases 
which are met with in our hospital practice, that 
you will often learn more than if we were to 
bring to your notice half a dozen cases in rapid 
succession. In examining one of these cases in 
order to make out a diagnosis, the physician is 
obliged to resort to his books, to bring to bear 
upon the case all the knowledge which modern 
physiology and pathology give us, and nothing 
is more calculated to exercise and strengthen 
the intellectual powers than the processes of rea- 
soning, by which, after a careful survey of the 
facts, we finally arrive at a conclusion. 

Of all obscure and difficult cases, those of the 
brain are most so, and for this reason we have 
brought before you this patient, who offers an 
interesting and striking example of cerebral 
disease, obscure in its commencement, chronic 
in its course, and doubtful, probably fatal, in 
its termination. 

The patient now before you is a woman, born 
in Ireland, 36 years of age, and married. From 
what we can learn, her history is as follows : 

History. — The patient has been married over 
twelve years. About fifteen years ago, she and 
her friends tell us, she had an attack of typhoid 
fever, and sometime afterward, an attack of 
some kind of skin disease, which she describes 
as having formed a solid scab all over her body, 
and which she informs us the physician who 
attended her did not designate by name, but 



called it " an eruption of the blood." She was 
ill with this about three months. This was 
about nine years ago. 

After having recovered from this attack, she 
continued well for six years, "as sound a 
woman," she says, "as you would meet." 

Her present illness began about three years 
ago. One day she was scrubbing on the porch, 
when she suddenly fell down, blackening her 
eye. She, however, soon recovered from the 
effects of this fall, which, from all that we can 
learn, was not very serious in its nature ; she 
was not insensible after this fall. Four months 
after this she was confined ; about five weeks 
after this she began to be attacked with dizzi- 
ness, and now we come to the first striking 
point in her case. 

She went, three months after confinement, on 
a visit to a friend, several hundred yards from 
her residence, and had great difficulty in reach- 
ing home, feeling dizzy and weak, having 
muscae volitantes, and staggering like a drunken 
person. Ever since that time she has been get- 
ting worse. Her gait became so uncertain and 
staggering, that conductors would not permit 
her to enter the cars, considering her intoxi- 
cated, and frequently she stumbled and fell. 
During this whole period she has suffered from 
pain in the head. 

She was again confined six months ago, the 
child having since died. She has not been able 
to do her washing or any hard work for a year or 
more. In other respects, her general health is 
good. Her bowels have been habitually torpid, 
and much more so of late. Soon after her last 
confinement she began to complain of chilli- 
ness, and a sensation of cold in the right side 
of her body. From the fall, already alluded 
to, which she received a little over three years 
ago, she got, according to her statement, entire- 
ly well, though her husband thinks that it was 
the cause of her illness. She herself dates her 
present disease from the time of the visit re- 
ferred to. 



LECTUKES. 



Vol. V, No. 1. 



In reference to the mental condition of the 
patient, her husband assures us most positively 
that she was never insensible ; soon, however, 
after the visit spoken of, she becam.e deaf in her 
right ear. 

Somewhat later, there appeared weakness, and 
some running of the right eye ; then the ten- 
dency to fall became very marked ; when she 
attempted to get up to clean the windows, she 
was sure to fall. She never had any convul- 
sive movements, but the headache has been con- 
stant since that visit. 

Immediately before she made this visit she 
felt perfectly well. There had been nothing un- 
usual in the confinement preceeding, only that 
she did not appear to gather strength as rapidly 
as on former occasions, and on that account the 
nurse had to be retained longer than usual. 

Having thus given you, as far as possible, a 
history of the case, let us now examine the pre- 
sent condition of the patient. 

First, as regards muscular power, you observe 
that her left arm and left leg are stronger than 
on the opposite side ; the grasp of her left hand 
is more powerful ; and the difference is still more 
marked in the lower extremities, when, as an 
experiment, we tell her to straighten her leg, 
after having flexed it, and resisting her efibrts by 
the hand. The difference, however, is not very 
marked. Again, she tells us that when she at- 
tempted to walk, her left leg would be the best, 
and she preferred to place it first on the floor 
when getting out of bed. 

Secondly, if we examine her as to sensibility 
on both sides, we find that the right arm is less 
sensitive than the left ; but no appreciable dif- 
ference can be detected between the two legs 
above the ankle. There is, how^ever, evidently 
a loss of power in the reflex movements, for 
when the soles of the feet are tickled she does 
not draw them away with that force and sud- 
denness we see it in healthy individuals. 

Returning again to the phenomena of mo- 
tion, you perceive that when she is laughing, 
the right side of the face hangs a little, the left 
side being decidedly drawn to the left, and 
when asked to wrinkle her face and to look 
cross, you see that the muscles acting upon the 
left angle of the mouth, act with decidedly 
more force than thoii«e opposite. 

Again, the tongue when protruded, is pushed 
a little to the right of the median line. The 
right orbicularis palpebrarum is weaker than 
tiie left. When she is told to shut both her 
eyes and we attempt to open them, it requires 



a great deal more force to do so in the left, 
than in the right eye, showing that the contract- 
ive power is less in the latter. 

If we now turn our attention from the phe- 
nomena of motion and general sensation to 
those of the special senses, we find, in the first 
place, that the right ear of the patient is en- 
tirely deaf. She cannot even perceive the tick- 
ing of a watch, held directly over the right 
meatus, when the left ear is shut ; with the 
left ear she hears perfectly well. The vision in 
the left eye is more distinct, she states, than in 
the right, though the difference does not seem 
to be very marked. The pupils are equal in 
size and both act readily. The sense of smell, 
according to the patient's own statement, is 
very much diminished ; indeed she complains 
of having lost it entirely. On testing it by 
holding a bottle of cod-liver oil under her nose, 
she gave no sign whatever of appreciating its 
odor ; with aromatic spirit of ammonia, how- 
ever, the result was somewhat different. When 
this was applied she turned away, though it 
was evident that the left nasal passage was 
more sensible than the right ; besides, you must 
remember that ammonia is irritating and may 
produce an impression upon the branches of 
the nasal branch of the ophthalmic nerve, itself 
the first branch of the fifth pair, — which is dis- 
tributed to the inferior and exterior parts of the 
nasal passages, giving them their general sen- 
sibility, — and cause reflex movements without 
affecting the olfactory, indeed while the latter 
may be entirely paralyzed ; a phenomenon 
somewhat analogous to the reflex process of 
sneezing when we look toward the sun. 

The patient states that after her fall, she fre- 
quently saw double, and even now does so 
sometimes, though not as often as formerly. 
There is also occasionally a decided tendency 
to strabismus convergens — the right eye being 
clearly disposed to turn a little toward the 
inner canthus, though at times the left also 
seems somewhat inclined to turn inward, to a 
merely perceptible degree. There is a positive 
oscillatory, tremulous movement of the bulbs, 
to a very slight extent, noticeable now and then 
in a lateral direction. She has entire control 
over both levatores palpebrarum. 

Another very interesting symptom to which 
we have not yet alluded, is, that she has suffered 
from marked dysphagia ever since her fall, 
which becomes at times very unpleasant, caus- 
ing regurgitation of the food through the nose, 
and exciting fits of choking. She cannot swal- 



October 6, 1860. 



LECTURES. 



low either fluids or solids readily, and on this 
account lias to eat very slowly, and prefers soft 
solids, such as bread softened in tea or soups. 

In regard to the condition of her mind, ac- 
cording to her own account, her memory is 
much impaired ; still it is not entirely deficient, 
but rather slow and sluggish. Her speech is 
markedly slow and imperfect, rather mumbling, 
chewing her words, as it were ; quite different 
from her mode of speaking before she got sick ; 
her words are pretty well selected, but not 
clearly enunciated, the last letters or sylla- 
bles being lost in hurrying indistinctly over 
them. She is in good spirits, contented, and in 
excellent humor, laughing readily. 

There is no vomiting at present, though there 
had been considerable, some months before she 
entered the hospital. Her bowels are costive. 
The tongue is moist and slightly furred; her 
appetite variable. 

She cannot now walk alone with any secu- 
rity, but with assistance enough to steady her, 
or leaning on the bed, she can get down the 
ward. 

Here then, gentlemen, you have a history of 
the patient, as far as we have been able to as- 
certain it, and a precise account of her present 
condition. Now, what is the matter with the 
patient ? 

There has been gradual loss of power in the 
right side as evinced by the deafness of the 
right ear, the diminution of muscular power in 
the right extremities ; the sensation of cold and 
partial loss of sensibility on the same side ; the 
loss of muscular power on the right side of the 
face, the slight strabismus convergens. Con- 
nected with this there is . the loss of smell, the 
dysphagia, the mumbling speech, and the im- 
pairment of memory. All these symptoms 
point to disease of some kind in the left hemis- 
phere of the brain. But besides these, you have 
the staggering gait, evincing impairment of the 
power of co-ordinating muscular movements, 
and as experimental physiology has taught us 
that this power resides in, or is connected with, 
the pons Varolii or cerebellum, there is every 
reason to suspect that the morbid condition in 
the brain, whatever its nature, extends in this 
direction. 

The dysphagia to which this patient has been 
aubject is a symptom of considerable impor- 
tance. You recollect that the movements of 
the pharyngeal muscles in the act of swallow- 
ing are entirely automatic, independent of voli- 
tion, belonging to the order of reflex move- 



ments. N'ow it is by the impressions of food 
and other stimuli, made upon the branches of 
the glosso-pharyngeal nerve, and thence carried 
to the medulla oblongata, whence they are re- 
flected upon the motory nerves of the pharynx, 
that the act of deglutition is induced. In the 
patient before us, the glosso-pharyngeal nerve 
evidently has lost its sensitiveness, if not en- 
tirely, to a great extent ; hence it does not so 
readily convey the impression when food is 
present, to the centres, so as to excite the mus- 
cles of the pharynx to grasp and dispose of it, 
and the food either regurgitates, or coming in 
contact with the larynx, causes fits of choking. 
It is important to bear in mind the automatic 
nature of the movements of deglutition. In 
cases where the patient is unconscious, or in 
convulsions, and it is desirable to give medicines 
at once, you need not wait for consciousness to 
return, or for the convulsions to cease, before 
you administer your remedies. I have seen a 
case of violent convulsions in a little boy, ten 
years of age, caused by the presence of an enor- 
mous quantity of indigestible food in the 
stomach — where the attendants waited for two 
hours for these most horrid convulsions to cease 
before attempting to give an emetic, that would 
speedily have emptied the stomach and arrested 
the disease at once. In these cases, remember- 
ing the automatic, or reflex character of the act 
of deglutition, all you have to do, is to force the 
mouth open and gently pour your medicine in 
the back part of the throat, when the glosso- 
pharyngeal nerve will convey the impression 
to the medulla oblongata, which will reflect it 
to the motory nerves, and the patient will swal- 
low without difficulty. 

To return, however, to the case before us, ws 
must come to the conclusion that there is dis- 
ease in the left hemisphere, extending also down 
in the neighborhood of the fourth ventricle, the 
optic thalamus, or corpus striatum, and invol- 
ving to a certain extent the pons Varolii or th© 
cerebellum. 

Now what is the nature of the cerebral lesion ? 
It can hardly be presumed to be apoplexy, vfhich, 
as you all know, is the rupture of a blood-ves- 
sel, followed by extravasation and producing 
its efl'ects suddenly. This case has been much 
too slow and gradual to be considered one of 
apoplexy. If there has been a sanguineous effu- 
sion in this patient at all, it must have been 
very small and comparatively slow. But I think 
the theory must be discarded altogether. 

From the slowness and gradual progress of 



LECTURES— COMMUNICATIONS. 



Vol. V. No. 1. 



the case, together with its symptoms and his- 
tory already detailed, we are induced to look 
upon it, as one of chronic softening of the brain, 
involving chiefly the parts already mentioned. 

I need, of course, hardly tell you that the 
prognosis is not very favorable as regards a 
final recovery. 

As far as treatment is concerned, we must of 
course endeavor, as much as possible, to bring 
the patient into a condition that the brain may 
be properly nourished, so as to arrest, or at 
least to diminish, the rapidity of the disorgani- 
zing, softening process which is taking place, 
and to promote the absorption of any exudative 
material that may have been thrown out. For 
this purpose she has a nutritious but light diet, 
takes cod-liver oil, and iodide of potassium ; and 
as counter-irritation is frequently followed by 
the best effects in these cases, a seton has been 
placed in the nape of her neck. 



COMMUNICATIONS. 

Fibro-melanoid Tumor of the Antrum, re- 
quiring the Extirpation of the entire Su- 
per-maxillary Bone— Operation— Recovery. 

By F. HiNKLE, M. D., 

Of Marietta, Pa. 

March 9th, 1860. I was called to see Mrs. 
Wm. Gr., of Columbia, set. 35 years, married, the 
mother of five children — the youngest three 
years old — and now thinks herself near three 
months advanced in her sixth pregnancy. She 
is of healthy parentage, and has always enjoyed 
excellent health until about two years since, 
when she was attacked with severe inflamma- 
tion of the right lachrymal sac and its duct, for 
which she was treated by different physicians. 
About a year ago, she noticed a small tumor in 
the right nostril, which at first increased but 
slowly ; recently, however, it has grown rapid- 
ly to its present size. It now fills the entire 
antrum, the right nostril, from which it pro- 
trudes externally, and by displacement of the 
septum, causes such occlusion of the left, that 
it is with some difficulty an ordinary probe can 
be introduced. The nose is much pushed to 
the left side, and the orbital cavity so en- 
croached upon that the eye is displaced out- 
ward and upward, and rests against and upon 
the supra-orbital ridge. The integuments of 
the brow are thrown into numerous wrinkles, 
and upon elevating and retracting the upper 
lid, the whole globe of the eye seems to stand 



external to and rest upon the surrounding parts. 
The pressure upon the nerve has destroyed the 
sight of the right eye. Eecently the pain has 
much increased in the part, and she now suffers 
great inconvenience from the constant accumu- 
lation, in the fauces, of a viscid secretion, so 
tough as to require frequent removal with the 
fingers to prevent suff'ocation. The distress 
from this cause is very great, almost entirely 
preventing sleep, which gives to the patient a 
very haggard and worn-out appearance. 

Being an intelligent woman, I informed her 
that nothing short of the entire removal of the 
disease could afford her relief, and fully ex- 
plained to her the dangers — now greatly en- 
hanced by her being enciente — of so formidable 
an operation, and also the fact that should she 
survive the operation, the relief aff'orded might 
only be temporary, owing to the possibility of 
a recurrence of the disease. Satisfied that with- 
out relief from her sutFerings, a speedy death 
was certain, she begged that the operation 
might be performed as early as possible, being 
" willing to suff'er all things that her life might 
be spared even for a time to her little child- 
ren." "In my case 'tis die dog or eat the 
hatchet," was her laconic, but expressive reply, 
to the artist to whom she was sitting for her 
picture the day previous to the operation, upon 
being asked whether she was not afraid of the 
result of so formidable an operation. 

After mature deliberation upon her case, I 
decided to give her the benefit of an early ope- 
ration, believing, from the rapid progress the 
disease had already made, that before the pe- 
riod of gestation would be completed, the poor 
woman would be beyond the reach of help. 

March 22d, noon. Assisted by Drs. Eher, of 
Lancaster, and McCorkle, of Columbia, the pa- 
tient being placed under the influence of a mix- 
ture of three parts of ether and one of chloro- 
form, I made a semilunar incision from the 
angle of the mouth to a point midway between 
the ear and the external canthus of the eye, 
ligated the facial artery, and proceeded with a 
rapid dissection of the parts. Just beneath the 
infra-orbital foramen, I found the tumor pro- 
truding through the walls of the antrum, about 
the size of a dime. This being carefully dis- 
sected from the adjacent soft parts, I cleared 
the infra-orbital ridge and internal canthus, 
loosing the integuments as far as the tuberosity 
and median line of the nose, and while the flap 
was firmly retracted upon the forehead by one 
of the assistants, I separated the tumor from its 






October 6, 1860. 



COMMUNICATIONS. 



attachments witiiin the orbit, as far as they 
could be reached. The incisor tooth having 
been extracted two days previous, I now notched 
the alveolus and hard palate with the saw, 
and with one blade of the cutting forceps, care- 
fully introduced into the nostril and the other 
in the notch, divided the bone with a single cut. 
The malar bone was next freely notched on its 
under border, and with one blade of the forceps 
in the notch, and the other in the orbit, was 
transfixed into the spheno maxillary fissure, 
leaving the frontal and orbital processes as a 
future support to the ball of the eye, and then 
with one blade of the forceps introduced into 
the nostril, the division of the bony attach- 
ments was completed by cutting through the 
nasal bones and nasal process of the maxillary 
into the orbit. Depressing the mass with my 
left hand, I divided the remaining soft parts 

■ with the scalpel, and removed the entire mass 
of the disease, except a small portion that was 
closely adherent to the sheath of the nerve at 

■ the bottom of the cavity. The parts were next 

• sponged with a strong infusion of matico, which 

■ arrested the hemorrhage, after which every re- 
maining particle of diseased structure was care- 
fully removed. After suff'ering the cavity to 
remain exposed for some minutes, during which 

^ time it was freely sponged with cold water, it 
was filled with charpie, soaked in the infusion 
of matico, the flap brought down, and the ope- 
ration completed by the introduction of five 
sutures of silver wire, by which the parts were 
; admirably retained in situ. The patient was 
•; now removed to her bed, and cold water dress- 
: ing applied to the part. Being much prostrated, 
: a draught, containing brandy and spr. ammon. 
\ aromat. was ordered to be given occasionally, 

• until reaction was established. 

5 o'clock, P. M. Reaction fully established ; 
brandy and ammonia discontinued, and brandy 
I panada and milk and egg, ordered as nourish- 
■ ment during the night. Patient complains of 
pain, for which quinia sulph. gr. 2 and morph. 
sulph. gr. i, in syr. acaciae was ordered every 
three hours until relieved, and a lotion of liq. 
plumbi. subacetat. dil. and ext. belladonn^e, 
to be applied over the eye, around which there 
is some tumefaction, and discoloration from 
eflPusion of blood. The patient was again seen 
by Dr. McCorkle, at ten o'clock, and being 
quite comfortable after taking two doses of the 
anodyne mixture, it was discontinued. 

23d, 9, A. M. Patient has had several hours 



comfortable sleep during the night, from w^hich 
she seems quite refreshed. Pulse 90 ; skin 
moist. Continue same dressings to the wound, 
and use beef tea in conjunction with previous 
diet. 

Being unable to see the patient more than 
once daily, she was taken charge of by Dr. 
McCorkle, from whom she received every at- 
tention between the times of my daily visits. 

24tli, 10 A. M. Patient is very weak ; pulse 
100, and feeble ; complains of great nausea from 
the ofifensive discharge from the wound pouring 
into the throat ; has vomited several times. I 
renoLOved all the dressing from the cavity, and, 
after washing it well with cold water, filled it 
again with lint soaked in the infusion of matico, 
and anointed with castor-oil to prevent its ad- 
hering to the part ; continued the lotion and 
cold water dressing externally, and ordered diet 
of beef tea and milk-punch, and carb. ammon. 
gr. 2, and morph. sulph. gr. -g-, every four hours, 
in mucilage. At 8 o'clock, P. M., the nausea 
and occasional vomiting continuing. Dr. McCor- 
kle ordered a saline cathartic. 

25th, 10 A. M. Bowels have been moved ; 
vomiting less frequent, but nausea still con- 
tinues ; very weak. Beef tea and brandy to 
be taken freely, and continue ammonia mix- 
ture. At 4 P. M., Dr. McCorkle was summoned 
to the country, at which time our patient was 
much more comfortable. Late in the evening, 
she was induced by a friend to take some warm 
oyster broth, by which the dressing of the ca- 
vity was saturated, and a slight capillary he^ 
morrhage brought on, which gradually increased 
until about midnight, when, the family becom- 
ing alarmed, the doctor was sent for. Finding 
that the patient was rapidly sinking, and that 
the readjustment of the dressings, and the in- 
troduction of fresh portions of lint, had only 
temporarily arrested the hemorrhage, I was 
summoned to his aid, and at 2 o'clock A. M., of 
the 26th, found the patient almost in articulo 
mortis ; pulseless, with blood oozing freely from 
both mouth and nostrils, and frequent retch- 
ings, as if to free the stomach of the blood 
which had found its way into that viscus. I 
immediately removed from the mouth and fau- 
ces large clots of blood, gave a large draught of 
brandy and ammonia, and as speedily as pos- 
sible removed all the dressings from the cavity, 
and by sponging it with the strong infusion of 
matico, and refilling it with the charpie satu- 
rated with that liquid, succeeded in arresting all 
bleeding. It is the opinion of Dr. McCorkle, 



COMMUNICATIONS. 



Vol. V. No. P. 



that tlie patient had lost not far from three 
pints of blood, and so great was the prostra- 
tion, that, notwithstanding the active adminis- 
tration of the strongest diffusible and nervous 
stimulants, her life was despaired of for some 
hours, during which time she passed from one 
state of syncope to another, with cold extremi- 
ties and occasional convulsive paroxysms. 
There was also constant nausea and severe 
retching. Ice was given freely, spice plasters 
applied over the abdomen, and sinapisms and 
hot alcoholic fomentations to the extremities. 
10 o'clock A. M., nausea and vomiting subsided ; 
patient comfortable, but very weak. Ordered 
wine and egg, and beef tea and brandy, and 
left patient in care of Dr. McCorkle. 

27th, Si o'clock A. M. Patient has rested 
pretty well since I last saw her. Complains of 
some pain in the wound in which there is now 
considerable tumefaction, and the areolar tissue 
around the eye is filled with and discolored by 
the blood effused during the efforts at vomiting. 
Apply cold poultice of elm bark, ext. arnica 
and powdered alum over the eye, and continue 
cold water dressing to the wound. 

From this time forward, there was no unto- 
ward symptom. The pain, tumefaction, and 
discoloration, gradually subsided. The patient 
being very anfemic, I prescribed syr. ferri et 
quin. cit., with good diet ; stimulants as re- 
quired, gradually substituting malt liquors for 
the alcoholic stimulants ; the bowels kept solu- 
ble with mild laxatives when necessary, and 
the wound regularly dressed. The patient's 
health and strength gradually improved, and in 
six weeks from the time of the operation she 
was able to walk about the house, and, during 
the seventh week, walked two squares on the 
street, supporting herself on her daughter's 
arm. 

May 23d, 10 o'clock P. M. Dr. McCorkle at- 
tending, she was delivered of a male child, dead, 
of about Sg- months. Two days previous, she 
had fever and swelling in her limbs, and from 
that time felt no further motions of the child. 
Immediately after her delivery, she said she 
felt "like a new woman." 

May 24th. Pulse 100; skin normal; no fe- 
ver ; tongue clean ; appetite good ; ate a piece 
of toast just before my arrival; complexion 
good ; expression cheerful, and general appear- 
ance healthy. 

From this time she steadily improved in 
health, and on 

July 17th, visited me at my office ; she says 
she now enjoys as good health as she has ever 



done ; is quite cheerful, and, were it not for a 
scar, resulting from the application of some 
escharotic by an empirical practitioner some 
months previous to my seeing her, would show 
but few marks of the severe operation to which 
she had been subjected. 

Before the operation. After the operation. 




The Present State of Ophthalmoscopy. 

Br Max Kuechler, M. D., 

Of Newark, N. J. 
No. 9. 

Pathological Changes of the Betina — Detachment 
and Separation of the Hctina. The retina, in its 
normal position is situated parallel to the cho- 
roid coat, upon the inner surface of the latter, 
and is connected with it by a thin cellular ma- 
terial. It is seen, upon intraocular illumination, 
as a light grayish film or mist, sj^read over the 
choroideal pigment, which often, however, es- ' 
capes the eye of the observer, especially when 
the choroideal pigment is light. Frequently, 
however, we are enabled to recognize the retina 
with the unarmed eye. 

In consequence of morbid processes occurring 
in the choroid, especially of exudations and 
extravasations taking place between it and the 
retina, the retina may become detached from 
its choroideal attachment, and protrude forward 
toward the dioptric apparatus. It does not, 
however, separate at its point of attachment to 
the optic nerve, (Fig. 
1. A,) nor where it is ^ig-l- 

attached to the cilia- 
ry body(B); while the 
whole of the interme- 
diate portion of the 
retina, between these 
two points may be de- 
tached, generally as- 
suming a form as j^re- 
sentedinFig.l. Most 
commonly only the lower part of the retina 
separates, and forms a sort of a sac with a 
cloudy surface. Where this merges into the 
normal portion of the retina, i. e., that which 
remains joined to the choroid, it is either smooth, 
flat, or forming folds, — bulging. 




October 6, 1860. 



COMMUNICATIONS. 




The detachment of the retina, once com- 
menced, generally progresses, and a portion of 
the retina, once separated, will rarely become 
re-attached, and even if it should, will never re- 
sume its physiological function. 

If the retinal detachment progresses in ex- 
treme cases, the membrane may become sepa- 
rated completely, and retain no point of attach- 
ment except around the contour of the optic 
nerve and its point of 
insertion into the iris. ^^^' ^' 

In this case the re- 
tina, on examination 
with the ophthalmos- 
cope, assumes a fun- 
nel-shaped form, 
(Fig. 2,) and in the 
centre of the funnel 
we see the intraocu- 
lar end of the optic 
nerve. 

As already stated, it is not absolutely neces- 
sary to use an ophthalmoscope in order to re- 
cognize a retinal detachment. By placing one's- 
self, with the back toward a window, and the 
patient in front, by letting him move his eye 
i^pward and downward, we can readily con- 
..vince ourselves that the pupil has a grayish 
glimmer at the point of detachment. The 
vessels running across this point make the diag- 
nosis certain, and prevent the case from being 
confounded with opacity of the vitreous humor. 
The ophthalmoscope, however, renders the 
image much more clear and distinct. At the 
moment when the focus is thrown. into the back- 
ground of the eye (upright image,) we see the 
fundus apparently normal ; but as soon as we 
throw the focus somewhat more anteriorly, the 
retinal detachment appears in the shape of a 
gray cloud, over which vessels are seen to run 
in wavy curves, irregularly, in a direction to- 
ward the observer, moving like clouds, some- 
times disappearing, then again coming into view. 

The retina, which 



in this condition 
forms folds, gives to 
the vessels, which 
run upon and with 
it, frequently the ap- 
pearance as if they 
were broken or dou- 
bled upon t h e m - 
selves. For instance, 
in Fig. 3, we will 
onlv be able to see 



rig. 3. 



the parts A and B, while at C, D, the ves- 
sels of the portions forming the folds, will 
of course be hidden from our eye. Now, if, 
for instance, a vessel enters this fold, two will 
apparently make their appearance at C, D ; we 
then obtain an image represented in Fig. 4 ; 
A, the optic nerve ; B, the retinal vessel of the 
detached retina ; C, D, the fold of the retina, 
where the vessel branches off into two ; E and 
F, the two branches of the vessel appearing as 
if cut off. Fig. 5, shows the lateral appearance 
of the parts in this condition. 



Fig 4. 



Fig. 5. 





All these appearances may be seen with the 
upright image. By having recourse, however, 
to the inverted image, they all become clearer 
and more distinct. If the double convex lens 
used, is moved to and fro, the gray opacity, or 
cloud, and its vessels, will follow the lens and 
pass more rapidly over the fundus of the eye. 

But if we have stated that a detachment or 
separation of the retina can readily be recog- 
nized by its grayish glimmering color, we must 
add, that this is not true in all cases, because 
the color of the detached retina depends upon 
the condition of the choroid or the media that 
have been deposited between the choroid and re- 
tina. These exudations vary much in their na- 
ture ; but they are mostly bloody or watery. If 
the exudation is of a clear, watery, fluid charac- 
ter, the retina will appear of the above described 
color. But as the color of the exudation varies, 
the color of the retina will of course present 
corresponding variations of tint. But if there 
is an extravasation of coagulated blood behind 
the retina, the retinal detachment will be more 
distinctly marked. The coagula will strongly 
reflect the incident light, and hence the fundus 
of the eye remains comparatively un-illumi- 
nated, in consequence of Vv'hich the detached 
portion of the retina will appear of whitish, 
grayish, or even greenish color, just according 
to the susceptibility and sensitiveness of the ob- 



8 



COMMUNICATIONS— HOSPITAL PKACTICE. 



Vol. V. No. h 



server's eye for the refraction of red colors. In 
short, the color of the image in detached retina 
depends upon the contents of the retinal sac. 
We can see this most clearly in cases, where in 
the same retinal sac we have exudations or 
extravasations of different color and consistence, 
which give to the detached retina different 
colors at different points. 

Correct, however, as the statement may be that, 
as a general rule, the coloration of the retina 
depends upon the back ground, yet there are 
other cases, where the retina is recognized by 
its grayish tint ; especially at the contours of 
the detached retina we find a whitish colora- 
tion, which, in the direction in which the detach- 
ment lies, blends into a grayish white ; but in 
the direction where the retina is normal, little, 
or nothing, of this grayish glimmer is seen. 
Furthermore, if the retina changes its normal 
position, and becomes detached but in the least, 
it loses its transparency in a marked degree. 
When considerably magnified, and examined 
by the upright image, adding a lens to the diop- 
tric apparatus, we see upon the retina strise, 
representing fasciculi of nerve-fibres ; besides 
these are seen little points, being cell-granules, 
first recognized by Dr. Liebreich, and not, as in 
morbus Brightii occurring densely grouped, but 
distributed equally fine over the membrane. 

The vessels of the detached retina are essen- 
tially modified in their color and course. Cir- 
culation, as a general rule, continues in them ; 
only where they are strongly bent or doubled 
upon themselves; the circulation becomes inter- 
rupted at these particular points. 

The color of the vessels may be dark-red, 
brown-red, merging into black, and they appear 
the darker, the darker the fundus of the eye, or 
the darker the material exudated or extravasa- 
ted into the retinal sac. If the fundus of the 
eye is greenish or brownish, the vessels will look 
blackish ; when it is red, they will present more 
of their normal red color, just as when we paint 
crimson upon a green or black ground, the red 
assumes a darker, more blackish tint, while 
painting red upon a red ground only renders the 
color more prominent. 

Detachment of the retina is distinguished 
from detachment of the retina and cJioroidea by 
the former presenting a more flattened appear- 
ance, while the latter forms a more bulging 
smooth tumor, over which the retinal vessels 
pass perfectly smooth and in a straight course. 
The choroideal vessels further aid in forming a 
diagnosis. 



Anomalies of Circulation in the Retina. — It is diffi- 
cult to determine a deviation from the normal 
fulness of the choroideal vessels. They are 
lying in a network too dense and narrow, im- 
bedded in a pigmentary stratum, and overspread 
by layers of pigment. The retinal vessels, on the 
contrary, have a very feeble contour, are plainly 
seen to emerge from the optic nerve, lie in the 
clear retina, and hence we are able to detect 
even the slightest change in their fulness. But 
in spite of this, it is difficult to recognize a true 
hypergemia of the retinal vessels, because the 
circulation of the blood varies so miich in differ- 
ent individuals, and because, in consequence of 
slight causes, hypersemia may arise, by no 
means morbid ; for instance, in bending forward. 

A considerable fulness, however, of the retinal 
arteries and veins, such as is found, often 
enormous, in persons working over fire, cannot 
be mistaken. But if the vascular fulness is not 
thus extremely developed, its diagnosis is often 
very difficult. In the same manner a general 
diminution in the calibre and fulness of the 
vessels is not easy of recognition. For a close 
examination of these conditions, it is necessary 
not only to inspect the veins and arteries at 
a particular point, and to compare them, but 
also to follow them through their whole course. 

In atrophy of the retinal arteries and veins, 
we see these vessels gradually become more and 
more attenuated, until they really look like a 
mere white stripe. Some blood is seen to pass 
through in the early stage ; later this disappears, 
until at last the vessel looks but like a thin 
white thread. 



[lletraticHS nl Jnspital frur&L 



PENNSYLVANIA HOSPITAL. 

Service ot Dr. J. Forsyth Meigs. 
ACUTE PHTHISIS. 

T. E., 38 years of age, was admitted into the 
hospital, September 9th, 1860. 

History. — Eighteen months ago he had been 
an inmate of the hospital, suffering from mania 
a potu, from which he entirely recovered. He 
then went to sea. On the 30th of last April, he 
came into the house again with an attack of 
syphilitic rheumatism, for which he was treated, 
and was discharged cured on the 31st of May. 
At that time, Dr. Keed, the house physician, 
reports his health as seemingly perfect, pre- 
senting no sign of serious disease. From the 
time he left the house, in May, he has made 
several trips down the bay as deck-hand, and 



October 6, 1860. 



HOSPITAL PEACTICE. 



been engaged in work along tlie wharves at odd 
jobs, drinking heavily, when he had money. 

For a month before he came to the hospital 
the last time, he had felt badly, and two weeks 
before ceased to work, and was at a boarding 
house, spending a part of his time in bed. A 
week before he entered he was quite unwell, 
had some diarrhoea, cough, and fever ; no appe- 
tite, loss of strength and flesh. 

After he came into the house he had some 
five or six stools in rapid succession. He was 
very weak, had much cough, in paroxysms, 
very severe and violent, witli painful dyspnoea 
after coughing, which on one or two occasions 
became so severe as almost to amount to cramp. 
The fever was rather slight ; skin soft and 
moist ; face dusky and pale. He complained 
of pain. Expectoration was rather scanty and 
difficult ; the sputa consisted of dark-colored, 
thick mucus, intermingled with watery fluid ; 
some of the thick masses which he expectorated 
were mixed with some blood ; it was, however, 
not the thoroughly mixed rusty mucus, but the 
blood appeared in small masses or streaks, and 
usually of a dark venous tint. 

The tongue was moist, not much furred, yel- 
lowish ; but there were no sordes. There was 
epistaxis. For a few days before admission, he 
had had diarrhoea, amounting to from three to 
six passages a day. The abdomen was not at all 
distended, but slightly tympanitic below, while 
the liver extended down the right hypochon- 
drium to below the umbilicus and across the 
epigastric region into the left hypochondrium. 
There was, however, no tenderness, no ascites, 
no gurgling, no eruption. 

Physical Examination. — Auscultation on the 
first day of his admission yielded a fine, bub- 
bling crepitus, confined to inspiration, over the 
lower fourth of the lungs behind. But though 
fine, this crepitus was not as dry as the true 
crepitus of pneumonia ; it extended upward 
rapidly. There were no sibilant rales present, 
indicative of bronchitis, but a faintly marked 
bronchial respiration was discovered as the 
case progressed. Percussion was clear and 
sonorous. Two days before his death a faint, 
imperfect crepitus could be heard with some 
difficulty over both mammary regions in front, 
but there was no well marked metallic bron- 
chial respiration, nor could any friction sound 
be discovered. 

The cardiac sounds were normal. He had 
mild delirium at night, which increased, and 
he became drowsy through the day. 

There was no vomiting. The condition of 
his mind was good. He had no headache; 
when roused he would be awake at once, and 
answered questions quickly and correctly, only 
in an abrupt, irritated way. He had the ap- 
pearance of a very ill and suffering person. 

Immediately on his entrance into the hos- 
pital, taking in view the low state in which the 
patient was, he was ordered milk punch, a 
wine-glassful every two hours; a tannin and 



opium injection, to restrain the diarrhoea, and 
a cough mixture, composed of muriate of am- 
monia, syrup of tolu and liquor mor[:)h. sulph. 
He was dry-cupped over the back, and a blis- 
ter put in front over the chest. 

Diagnosis. — It is acknowledged by the best 
authorities here and on the Continent, that the 
diagnosis of acute phthisis is sometimes ex- 
tremely difficult. In this case, it might have 
been confounded with typhoid fever. The pa- 
tient had had epistaxis, diarrhoea, was very 
feeble and low, and had a certain amount of 
delirium. But he had had no rose-colored 
eruption, no tympanitis, there were no sordes, 
no gurgling in the right iliac fossa. There was 
an absence of the sluggishness, with slow wak- 
ing up and slow answers, as we find it in 
typhoid fever. Again, we do not find in typhoid 
fever the liver enlarged, as it was in this case ; 
and this led to the assumption that the organ 
had undergone fatty degeneration in conse- 
quence of tubercular diathesis, especially as he 
had been a hard drinker. 

Again, acute phthisis must be distinguished 
from pneumonia. There was in this case, it is 
true, a fine bubbling crepitus over the posterior 
lower part of the lungs, but not as dry as the 
true crepitus of pneumonia. There was a faintly 
marked bronchial respiration, but no sibilant 
rales, nor the well marked metallic tubular 
respiration. 

Some observers state, that typhoid fever can 
be distinguished from acute phthisis or other 
diseases, by the peculiar musty odor present in 
the former. 

Taking all the facts and symptoms, together 
with the history of the patient, into considera- 
tion, the case was diagnosed as one of rapid, 
acute tuberculization, and this was verified by 
the post-mortem examination. 

Autopsy. — With the exception of one or two 
very small adhesions, the pleura was healthy. 

Both lungs were fairly riddled with tubercles. 
They contained immense numbers of miliary 
tubercles, most abundant in the upper lobes, 
though very numerous also in the lower. The 
lower portion of the inferior lobes were of a 
deep red color, crepitant, but rather firmer than 
usual, and containing a great deal of blood. A 
piece cut off from the lower lobe floated, but 
after being squeezed, it sank. 

The heart was healthy. 

The liver was very much enlarged, perhaps 
to one-half its natural size, weighing between 
five and six pounds. Under the microscope, it 
was found far advanced in fatty degeneration. 

Peyer's glands were perfectly healthy. 

SUBCUTANEOUS INJECTIONS. 

A patient was brought before the class who 
had entered the hospital on the 20th of Sep- 
tember, suffering severely from pain in the left 
lumbar region. He has had this pain since 
February — 7 to 8 months. On a careful exami- 



10 



HOSPITAL PEACTICE. 



Vol. V. No. 1. 



nation, nothing was discovered tliat would give 
rise to the pain. He enjoyed general good 
health ; had no fever ; no loss of flesh. There 
was no pain at the glans penis, scrotum etc., as 
there would be if the pain was owing to stone 
in the bladder, or the passage of renal calculi 
through the ureters. The urine was perfectly 
healthy ; appetite and digestion good. The di- 
agnosis was hence limited to chronic neural- 
gic afl:ection of the lower intercostal and lum- 
bar nerves. A hypodermic subcutaneous injec- 
tion of 20 minims of a solution of morphia, of 
the strength of 16 grains to ^i of water, was 
resorted to as soon as he entered, when the pain 
at once disappeared, and has not since returned. 
He was ordered to take twice or three times a 
day 10 drojDS of the tincture of nux vomica, 
with 1 drachm of compound tincture of gentian. 
Dr. Meigs remarked, that the subcutaneous 
injection of morphia had been resorted to 
considerably in the hospital, with very good re- 
sults ; only in one or two cases had furuncles 
made their appearance at the seat of injection. 
Atropine has not been used. ' 

CASE OF E3IPTEMA IN A BOY, WITH SPONTANEOUS 
FISTULOUS OPENINGS. 

This patient is a little boy, nine years of age, 
whose illness dates back over a year. A year 
last April he was taken with pain in his side, 
and some cough. He remained in bed then for 
about a week. About three v/eeks later he be- 
came worse again. Somewhat later a swelling 
made its appearance on the right side, pretty 
large, nearly the size of a iist, which broke 
about the 4th of July, 1859, and discharged a 
large quantity of pus. At that time he was 
very sick, had fever, oppressed respiration, but 
not much cough. 

It is a marked case of chronic pleurisy, fun- 
ning into empyema. 

On physical examination, the right side is 
found to be markedly contracted. The sound 
side measures 12 inches in circumference, the 
right only 9J, a difference of 2| inches, which 
is remarkable in so young a patient. Two 
causes contribute to this. In the first place, the 
contraction of the sick side, in consequence of 
the compression of the lung, which is bound 
down by the adhesions ; and secondly, the supple- 
mental expansion of the sound side, in conse- 
quence of increased respiratory action of that 

Auscultation yields friction sounds, and more 
or less of coarse, rough, harsh, vesicular mur- 
murs. On percussion, there is strong, full pul- 
monic resonance on the left side, while on the 
right the resonance is feebler, and has the pe- 
culiar wooden or tubular sound. 

Although the suppurative process may be 
arrested, it is very rare, when the disease has 
lasted for any considerable length of time, that 
the lung ever expands to its former capacity. 



This is because it is not only contracted in con- 
sequence of the fluid mass pressing upon it, but 
also bound down by firm adhesions of plastic 
material. 

Dr. Meigs, in alluding to the importance in 
these cases of making an early diagnosis, refer- 
red to the case of a boy, 10 years of age, where a 
chronic pleurisy, with empyema, had been mis- 
taken for typhoid fever, and the fistulous open- 
ings for secondary subcutaneous abscesses. , 

The patient, in the present instance, has of 
late been put on tonics, cinchona and iron, with 
a good nutritious diet, and been sent to the 
country, and under this treatment and regimen 
appears to improve. But his lung will never 
resume its normal expansion, on account of the 
plastic material thrown out on the pulmonary 
surface of the pleura, which binds it down, and 
his right side and shoulder will always be more 
or less contracted. 



PHILADELPHIA HOSPITAL. 

Service of Dr. R. J. Levis. 
CASE OF EXTENSIVE VENEKEAL VEGETATIONS. 

Sarah A., aged twenty-five, recently entered 
the hospital for relief from an enormous collec- i 
tionof warty growths on and within the external 
genitals. Her sufferings were very great, and 
she was nervous and debilitated. The discharge 
of a disgustingly offensive ichor from the parts 
made her presence intolerable to other patients 
in the wards. 

While in the hospital last spring, suflering 
from gonorrhea, the growths were excised, and 
the surfaces cauterized, but they rapidly re- 
appeared, and spread extensively. 

The efficient treatment of such vegetations 
from the mucous surfaces of the genitals has, 
in this hospital, usually been the application of 
either chromic or nitric acids, or more gene- 
rally deep excision of the growths with the 
scalpel or scissors. Their existence has always 
been traceable, though sometimes rather re- 
motely, to the irritating discharges from either 
gonorrheal or chancrous surfaces ; but more 
particularly from the former. They certainly 
cannot be classed as symptoms of secondary 
syphilis, but are produced simply by local irri- 
tation, and are never inoculable. Their occur- 
rence is much favored by the uncleanly habits 
of the patient, allowing acrid secretions to re- 
main in contact with vascular surfaces. In 
females, they most frequently commence within 
the labia, near the commissures ; and in males, 
at the junction of the prepuce with the corona 
glandis. 

The cut illustrates the prominence and great 
extent on the surface, of the vegetations in this 
case. They were very red, sensitive to the 
touch, and evidently highly vascular, and ex- 
tended from the inner and outer surfaces of the 
entire labia, over the perineum to the anus. 



October 6, 1860. 



HOSPITAL PRACTICE. 



11 




The operation of excising them was deter- 
mined upon, but as merely shaving them off 
had been previously followed by a return of the 
affection, and as less hemorrhage was to be 
anticipated by a deeper removal — cutting below 
the extremely vascu.lar tissue — the mass was re- 
moved along with the skin and mucous mem- 
brane involved in it. 

The hemorrhage was nevertheless very great, 
requiring the excising to be frequently stopped 
for the ligating of numerous large vessels. 
When the entire growth had been removed, the 
edges of the integument around the denuded 
surfaces were drawn together, and united by 
silver sutures. Although this union was in 
some places held with much tension, the su- 
tures retained their positions until nearly all 
the edges had united. 

The excised surfaces have now either united 
or completely cicatrized, and the jaatient is im- 
proving in general health. 



EPISCOPAL HOSPITAL. 

Service of Dr. R. P. Thomas. 

[Reported by Dr. B. E. Fryer.] 

TWO CASES OF FRACTURE OF THE FEMUR, WITH A 

NEW APPARATUS. 

Case 1st. — Levi B., English, aged 57, was ad- 
mitted into the house with a compound fracture 
of the femur at its lower third, caused by a heavy 
casting falling on him. The direction of the 
fracture was oblique, and being a very muscu- 
lar man, it was found impossible, with the old 



counter-extending band, to prevent excoriation. 
The adhesive strips had been tried, and inva- 
riably slipped, and as it was also difficult to 
prevent eversion of the foot, Dr. Thomas sug- 
gested an entirely new apparatus. It consists 
of a long fracture-box, with the outside leaf run- 
ning up to the axilla, and the inside one nearly 
to the perineum. The counter-extension is made 
by having a piece of thick iron wire, say ^ inch, 
in the shape of an U, and curved upon itself 
midway, to an angle of forty-five degrees ; this 
is firmly clamped to the floor of the box at its 
upper edge, and the counter-extending tapes 
fastened to the cross piece of the U. The ex- 
tension band passes over a roller, fastened by 
pegs, below the foot-board, and may be tightened 
at pleasure by turning the roller and shifting 
the pegs to retain it. 

The advantages claimed for this apparatus 
are, 1. That the counter-extending force is ap- 
plied in the direction of the axis of the leg ; 2. 
The counter-extending band does not excoriate, 
as it only makes pressure upon the tuber ischii ; 
3. The lateral support given prevents the possi- 
bility of any eversion of the foot, while the floor 
of the box obviates the danger of deformity 
from sinking of the bed ; and 4. The facility 
with which dressings may be applied in com- 
pound fractures. 

Though this was a very unfavorable case for 
the trial of a new apparatus, the man has re- 
covered Avithout shortening, and with as useful 
a leg as before the injury. 

Case 2d. — Bridget C. was admitted into the 
house for a dislocation of the femur, so repre- 
sented by the practitioner v/ho sent her to the 
hospital. The position of the foot, which was 
everted, with a considerable shortening of the 
leg, at once led us to suspect a fracture of the 
neck of the femur, which, upon a careful ex- 
amination, proved to be the case. 

She was placed in Dr. Thomas' apparatus, 
and has recovered without shortening. 

CURIOUS CASE OF FRACTURE OF BOTH BONES OF THE 
LEG. 

John Daly, Irish, aged 26, while sitting on a 
coal car, with the sole of his foot resting on the 
one in front, the engine pushed the cars to- 
gether, bent his leg upward and outward over 
the thigh, thereby causing a fracture of both 
tibia and fibula, about two inches below the 
knee-joint, and tearing the hamstring tendons 
so that the bellies of the muscles were drawn 
up very considerably. 

The leg was placed in a fracture box, and 
cold water constantly applied to the joint, to 
keep down inflammation, which at one time 
was excessive. At the end of four weeks the 
leg was put in a starch bandage, and in seven 
weeks he left the house cured. 

The manner in whicn this fracture was pro- 
duced, is interesting. The leg being bent up 



12 



HOSPITAL PEACTICE— MEDICAL SOCIETIES. 



Vol. V, No. 1. 



• 



over the thigh, pressed the head of the tibia 
against the condyles of the femur, so as to cause 
a resistance sufficiently firm to snap the bones 
close to the resisting point. A fracture of both 
bones, so near the joint, is rarely seen. 

FRACTURE OF CLAyiCLE AND STERXUM, COMPLICATED 
WITH WOUXD OF LUNG. 

Frederick S., a Grerman, aged 50, fell from the 
side of a ship, and struck his shoulder on a large 
piece of timber lying on the wharf, producing 
a fracture of the left clavicle and articular edge 
of sternam, also dislocating the clavicle, and 
driving the sharp fractured edge down on the 
lung, which it wounded, so that air could be 
felt in the surrounding tissues, and also passed 
out at a small wound, in bubbles, with the 
blood. 

The fragments were moulded together, and 
the dislocation reduced. The wound was closed 
with adhesive strips, and a compress placed 
over it, and Desault's apparatus for fracture of 
the clavicle applied. On the third day there 
was some pneumonia, which yielded to treat- 
ment, and the man was discharged cured in 
five weeks, with only a prominence at the ster- 
nal end of the clavicle. 



U^Htal Snridin. 



PEOCEEDINGS OF THE LANCASTEE CITY 
AND COUNTY MEDICAL SOCIETY. 

(Reported by John Levergood, M. D., Recording Secretary.) 

Meeting of August 22, 1860. 

Dr. a. Sheller (President) in the chair. 

Subject for Discussion : Veratrum Viride in 

Puerperal Mania. 

At the stated meeting of the Lancaster City 
and County Medical Society, August 22d, I860, 
the order of business being " verbal communi- 
cations from members,'^ 

Dr. John L. Atlee, Sen., said, that a case 
then recurred to him, which, although not one 
of frequent occurrence in practice, was, in all 
its relations, of so distressing a character, so 
uncertain, and sometimes so unsatifactory in 
its treatment, that he would bring it to the no- 
tice of the Society. He did so in the hope, that, 
should a case occur in the practice of any of 
those present, they might be induced to give the 
remedy, which, in his hands, had operated 
so beneficially, a further trial — especially as, 
after considerable experience, all other methods 
of treatment had been less speedily eff'ectual, 
and could, with less confidence, be relied on. It 
was true, that he had used the remedy in this 
case only ; and he believed that it was, so far 
as his reading extended, the only application of 



it to the treatment of the disease in question ; 
but he was decidedly of opinion, that to its in- 
fluence exclusively, the rapid recovery of the 
patient was attributable ; and he would rely, 
with some confidence, upon a similar result in 
future cases, if used at a very early period of 
the disease. 

On Wednesday morning, Nov. 9, 1859, be- 
tween 3 and 4 o'clock, he was called to see Mrs. 
S., aged 35, a native of Germany, of dark com- 
plexion and nervous temperament, who was then 
in labor with her eighth child. Her previous 
labors had been natural and easy, and had not 
been followed by unpleasant consequences. In 
this instance, he was told, that, on the Mon- 
day previous, a sudden rupture of the mem- 
branes had occurred, which, however, was not 
followed by uterine pains until Tuesday after- 
noon, when active and regular labor pains com.- 
menced. 

An uneducated German midwife had been 
with her, at intervals, for 24 hours, who, too 
ignorant to understand the cause of the diffi- 
culty, had kept the jDoor woman in great sus- 
pense and anxiety. About an hour before Dr. 
A. saw her, a better-informed German midwife 
was sent for, who discovered that the presenta- 
tion was preternatural, and requested his assist- 
ance. 

He found the os tincse fully dilated, and the 
right shoulder, and the cord, in which there 
was no pulsation, presenting. With but little 
difficulty, version by the feet was accomplished, 
and she was delivered of a dead child. After 
the delivery of the placenta, an anodyne was 
given, and he left the patient in a very com- 
fortable condition, and very grateful for the re- 
lief afibrded her after her prolonged suffering. 
He visited her on the three following days, at 
the expiration of which she was doing so well, 
that he ceased his attendance. At each visit she 
received him very cordially, and manifested 
strong feelings of gratitude. 

On the evening of the 19th, ten days after 
the delivery, her husband called upon the doc- 
tor, and stated that his wife was not so well as 
she had been, that her conduct was peculiar, 
and he was very uneasy about her. After some 
inquiry, a dose of cathartic medicine was pre- 
scribed, and a promise given to visit the pa- 
tient the next morning. 

Upon entering her chamber the next day, he 
was struck with the alteration in the counte- 
nance of the patient. Instead of the pleasant 
smile which welcomed his previous visits, she 
cast a suspicious look at him, and it was with 
great difficulty that she permitted any exami- 
nation. She would not speak a word, and with- 
drew her hand when he attempted to feel her 
pulse. Her husband informed him, that when 
he had given her the medicine the evening be- 
fore, she said that the doctor intended to poison 
her, and she seemed to distrust most of the per- 
sons about her, as having a design against her 
and her children. There was some accelera- 



October 6, 1860. 



medical societies. 



13 



tion of the pulse, but no evidence of general 
febrile disturbance, and no suppression of the 
lochia. No obvious cause was discoverable for 
the great change in her mental condition. In 
the hope that this change would be but tem- 
porary, a full dose of opium was left to quiet 
the nervous excitement, and prevent inordinate 
action of the bowels, which had been suffici- 
ently influenced by the cathartic. Perfect rest 
and quiet were enjoined ; and she was to be 
carefully watched to prevent injury to herself 
or others. On the next day, (Nov. 21,) the 
symptoms of puerperal mania were still more 
decidedly developed. It was impossible for the 
doctor to come near her. His presence seemed 
to terrify her ; and her husband told him, that, 
since the previous visit, she expressed strong 
apprehensions that the doctor had poisoned her, 
and meditated her destruction. She had slept 
little or none, and it was difficult to keep her 
confined to her bed and her room. 

For the reason previously stated, viz., the un- 
certainty of all previous methods of treatment 
in speedily arresting the progress of the disease, 
and the absence of any leading indication as to 
the immediate cause, he determined to put her, 
as soon as pps.sible, under the influence of the 
veratrum viride, in the hope, that, by controll- 
ing the general circulation and diminishing the 
nervous excitement — two properties which this 
medicine possesses in an eminent degree — some 
benefit would result. The saturated tincture, 
in doses of five drops every three hours, was 
ordered, and was to be continued as long as it 
did not produce nausea, vomiting, or prostra- 
tion. 

On the following morning, on entering the 
room, he found his patient lying calmly and 
quietly on the bed, with a total absence of the 
sinister expression of the day before. She 
answered him slowly, but in a whisper, put out 
her tongue, and let him feel her pulse without 
resistance. Upon inquiry, he found that soon 
after the administration of the third dose of the 
veratrum, on the previous evening, she had 
become calm, had rested quietly during the 
night, and had remained so. Her pulse was 
reduced in frequency to 56. In the use of the 
veratrum viride, in safe doses and at intervals 
of three hours, the doctor remarked, that in his 
general practice he had almost invariably ob- 
served that the circulation was not brought 
under its influence until after the third dose ; 
and he had reason to believe that in this case 
a decided amelioration in the condition of the 
patient had taken place as soon as its peculiar 
effect upon the heart had occurred. Of this 
fact, however, he could not be certain, owing to 
the ignorance of those around the patient. The 
medicine was continued, and on the next morn- 
ing there was an entire absence of all unfavor- 
able symptoms. The patient was cheerful and 
obedient, conversed rationally and freely, and 
without allusion to her previous unhappy con- 
dition. A laxative was ordered, and the vera- 



trum continued at intervals of four, and subse- 
quently of six hours, until the 27th, the pulse 
never rising above 60. On the 28th, twenty- 
four hours after the last dose, the action of the 
heart was sensibly free from its effects, without 
any return of the unfavorable symptoms ; the 
patient was in every respect well ; and he took 
leave of the case. Since then she has attended 
to her domestic duties as usual. 

He would remark again, that he was not 
aware that the veratrum had been used before 
in the treatment of puerperal mania ; but he 
wished that his medical brethren would give it 
a trial, should they have the misfortune to en- 
counter the disease. From its sedative influence 
upon the heart and nervous system, he thought 
it might be beneficially used in the treatment 
of some other forms of mania. 

Dr. Carpenter, related some cases of puerpe- 
ral mania, in which he stated that he had de- 
rived great benefit from the use of opium. A 
patient of his, some eight or ten days subsequent 
to parturition, was seized with an attack of 
mania, brought on by having been seen while 
en deshahille. He used opium, which evinced a 
decidedly beneficial influence over the disease. 
Dr. C. had used it in another instance in which 
the mania was produced by the husband return- 
ing home about the tenth day, and compelling 
his wife to have connection with him, and here, 
also, opium had a very happy effect. Dr. Car- 
penter has never employed veratrum viride in 
puerperal mania, but in certain cases, as those 
of great vascular excitement, the happiest re- 
sults were to be anticipated from its use. He 
condemned the indiscriminate employment of 
so powerful and dangerous a drug, and expres- 
sed the opinion that veratrum viride had ac- 
complished but very few of the numerously 
reported cases of cure that have been attributed 
to it. Dr. Atlee's case he regarded as a highly 
important and interesting one, and goes very 
far toward demonstrating the immense benefit 
we may expect to derive from the veratrum in 
puerperal mania. 

Dr. Ziegler remarked that, in his hands, the 
veratrum viride had received a faithful and ex- 
tended trial, and he was free to admit that, in 
the cases in which he had given it, it had proved 
beneficial beyond his most sanguine expecta- 
tions. He gave the history of a case of typhoid 
fever, in which, after almost every conceivable 
remedy had been employed unavailin,gly, and 
the patient seemingly beyond the reach of medi- 
cine. Dr. Z. made use of Tilden's preparation of 
veratrum viride, and succeeded in restoring his 
patient to health. He has employed the vera- 
trum in most of the diseases coming within the 
range of his practice, and that, too, with the 
most undoubted success. 

In answer to a question from Dr. Atlee, Sr., 
as to whether he had ever given it in cholera 
infantum, Dr. Ziegler replied that he had not, 



14 



MEDICAL SOCIETIES— PEEISCOPE. 



Vol. V. No. 1. 



but stated that in dysentery he liad derived 
great benefit from its employment. Dr. Z. was 
led, from his experience and observation, to be- 
lieve that the medicinal virtue of the veratrum 
viride was not owing exclusively to the sedative 
property it possesses, but that it, also, has an 
anodyne effect ; and further stated that, as the 
frequency of the pulse subsided, its volume in- 
creased. Dr. Zidgler concluded by expressing 
the earnest hope that the naembers of the So- 
ciety would give the veratrum viride a fair and 
impartial trial, and report the result of their 
observations at a subsequent meeting. 

Dr. Hinkle gave an account of a case of 
mental derangement, in which six grains of sul- 
phate of morphia are taken every twelve hours, 
but until he commenced giving the veratrum 
viride the narcotic had not the slightest effect 
in quieting the patient. He continues to give 
the morphia in conjunction with the veratrum, 
and a salutary effect is very manifest ; a cure 
is not anticipated. 

Dr. Parker remarked that, on numerous oc- 
casions, he had employed veratrum viride in 
puerperal fever, and with nearly uniform suc- 
jcess. He acknowledged himself to be an en- 
thusiastic advocate for its use in this disease, 
hi fact was almost disposed to regard it as a 
panacea. 

Dr. Cassidy followed with some observations 
on empirical practice, when the Society ad 
journed. 



EDlTOmAL DEPARTMEI^T. 
PERISCOPE. 

TRACHEOTOMY IN EPILEPSY. 

Tracheotomy in Epilepsy, although recom- 
mended by the very high authority of Marshall 
Hall, now over fifteen years ago, has of late 
fallen into disuse, at least not many cases have 
found their way into the journals. In the 15th 
September number of the Medical Times and Ga- 
zette, Dr. A. Wynn Williams communicates two 
cases of epilepsy, in which the trachea was 
opened. 

The first case was that of a young man, 18 
years of age, who had become attacked with 
epilepsy when ten years of age, the attacks hav- 
ing increased in frequency and duration in spite 
of every remedy that was thought likely to 
benefit him. Under these circumstances, tra- 
cheotomy was resorted to Sept. 10, 1855. For 
four or five months after the operation, the pa- 
tient was thought to improve, the fits becoming 
less in frequency and severity. In six months, 
however, they recurred as severe as before. 
The tracheal tube was worn for three years, 



without apparently influencing the progress of 
the malady. The case, however, is not con- 
sidered as one from which to form a fair esti- 
mate, the patient being much addicted to in- 
temperate habits, and Dr. W. states that had 
he been previously made aware of this circum- 
stance, he should not have proposed the opera- 
tion. 

The second case which Dr. Williams reports, 
is that of a man 25 years of age. He had been 
subjected to epileptic seizures in the night for 
many years, but had only been subject to them 
in the day for two years. He had, in conse- 
quence, been obliged to relinquish his employ- 
ment. He had undergone a good deal of treat- 
ment previous to coming under Dr. W.'s care. 
The operation was performed on July 9th, 1856. 
The patient went on very satisfactorily after the 
operation. The epileptic seizures became gradu- 
ally less severe and less frequent, and for the 
last two years he has had no attacks during the 
day time, and only very slight ones at night. 
At this time (Sept. 1860) he is in apparently 
good health, and has but rarely slight fits when 
in bed. He still wears the tube. 



PIARRH^MIA. 

Piarrhcemia, or milkiness of the serum of the 
blood, is the subject of some extended remarks 
by Dr. Charles T. Coote, of London, in the Lcm- 
cet of Sept. 7th and 15th, where he records a 
case of acute diabetes mellitus, accompanied by 
piarrhgemia. Some months ago. Trousseau, if 
we remember rightly, or some other prominent 
Parisian physician, presented before one of the 
societies a specimen of serous fluid, evacuated 
from a hydrocele, which was perfectly milky, 
looking like chylous urine, and he suggested 
that it should be considered a new form of hy- 
drocele. Within two months we were present at 
the post-mortem examination of a woman, about 
68 years of age, who was suffering from ascites 
in consequence of — as the autopsy revealed — a 
scirrhous tumor involving the pancreas. At 
two different times had this woman been tapped, 
and on each occasion gallons of a perfectly 
milky serum were discharged. On examina- 
tion, no fat or oil whatever could be found in 
the fluid, and the milkiness was, no doubt due 
to the presence of molecular albumen. In these 
cases, however, the piarrhgemia did not extend 
into the blood-vessels, rendering the blood itself 
milky, as in those mentioned by Dr. Coot€. 

After a careful comparison of the facts, th« 
author comes to the following conclusions : 

The conclusions which I should venture to 
draw from a comparison of the facts collected in 
this paper, are as follows : 

1. Piarrhaemia consists in an excess of saponi- 
fiable fat in the blood, not in the mere libera- 
tion of fat from its combinations. 

2. The excess of fat in the blood may be the 
result of two causes, viz : 



October 6, 1860. 



PEEISCOPE— REVIEWS AND BOOK NOTICES. 



15 



(a.) The excessive ingestion of fat, (as in 
piaiTlisemia during digestion.) 

{b.) The diminished elimination of the same, 
as in hybernation and pulmonary diseases. 

It is not quite clear to which of these catego- 
ries alcoholism belongs. It is conceivable that 
its elements may be clirecily converted into fat 
by deoxidation ; but it seems more probable that 
the conversion is effected indirectly, the hydro- 
carbon of the alcohol attracting to itself that 
free oxygen which w^ould otherwise have been 
employed in the combustion of the fats of the 
food, and so permitting the accumulation of the 
latter in the blood. 

3. Fat, if directly ingested, may enter the 
blood with the chyle through the thoracic duct ; 
but it is clear, from the present case, that it may 
also be elaborated in, and absorbed directly 
from, the liver. 

4. Piarrhsemia is not a result of diabetes mel- 
litus, for either may exist without the other. 
Both seem to be consequences of the same de- 
rangement of the functions of the liver which 
overloads the blood, sometimes with an excess 
of sugar alone, sometimes with an excess of 
sugar and fat combined. 

Why the liver should deal so differently in 
different cases with the hydrocarbons submitted 
to its influence, it is hard to say. It seems not 
improbable that sugar alone is elaborated in 
the first instance, and that the excess of fat is 
the result of a deoxidation of this substance ; 
for the conversion of sugar into fatty substances 
is not only capable of being effected experimen- 
tally, (as in the production of butyric acid by 
fermentation of sugar under the influence of 
casein,) but has been shown to take place in 
the animal economy, in the formation of wax 
by bees fed only on sugar. ■^" 

5. The pathology of blood milky from molecu- 
lar albumen, must be considered as still almost 
wholly negative. It is probably never an inde- 
pendent affection ; but neither is it a mere acci- 
dental consequence of piarrh^mia. Its appa- 
rent relation to albuminuria seems to point to 
some organic change in the constitution of the 
plasma of the blood itself. 



REVIEWS AND BOOK NOTICES. 

On the Diseases, Injuries and Malformations 
OF the Rectum and Anus, with Remarks on 
Habitual Constipation. By T. J. Ashton, 

Surgeon to the Blenheim Dispensary, Fellow of 
the Royal Medico- Chirurgical Society, Member of 
the Pathological Sodety of London, etc. With 
Illustrations. Philadelphia : Blanchard and 
Lea, 1860. 

This is a reprint of one of the most popular 
monographs in the language. The subject is 
one but slightly treated in general surgical lite- 

* Miller's Chemistry, vol. iii, p. 733. 



rature, and as a specialty for study and prac- 
tice it does not seem to be a favorite one. The 
great frequency of diseases of this region of the 
body among all orders of society, seems not to 
have increased the general knowledge of the 
subject, and there is no class of affections more 
frequently maltreated. A thorough examina- 
tion of the parts is often, with fastidiousness 
avoided, and, for want of a knowledge of some 
of its simplest pathological conditions, trifling 
affections remain the cause of life-long suffer- 
ing. We have known an apparently trifling, 
but intensely painful anal fissure, to be allowed 
to almost wear out the existence of a patient for 
the want of the little knowledge necessary for 
its effective treatment. 

We have considered affections of this outlet 
among the most painful diseases to which hu- 
manity is liable, and as those peculiarly predis- 
posed, without prompt treatment, to become 
chronic. 

The complex anatomical relations of the rec- 
tum, and its highly vascular and nervous orga- 
nization, give to its pathological conditions a 
morbific influence in the whole economy, which 
makes a knowledge of its diseases of the utmost 
importance to every medical and surgical prae- 
titioner. 

Those who have not studied the subject with 
special attention, will be surprised at the full- 
ness of this monograph. The treatise is divided 
into twenty chapters. The diseases of the anus, 
including Irritation and Itching, Inflamma- 
tion and Excoriation, Excrescences of the Anal 
region, Contraction and Fissure of the Anus, 
are considered in the first five chapters. Neu- 
ralgia of the Anus and Lower Extremity of the 
Rectum, Inflammation of the Rectum, Ulcera- 
tion of the Rectum, Hemorrhoidal Affections, 
Enlargement of Hemorrhoidal Veins, Prolap- 
sus of the Rectum, Abscess near the Rectum, 
Fistula in Ano, Polypi of the Rectum, Stricture 
of the Rectum, Malignant disease of the Rec- 
tum, Injuries of the Rectum, Foreign Bodies 
in the Rectum, Malformations of the Rectum, 
are the subjects of the next fourteen chapters, 
and the work concludes with a chapter of great 
value on the subject of Habitual Constipation. 

The work will be in general demand as a 
standard authority. It is well illustrated, and 
appears altogether in a very attractive style. 

The Principles and Practice of Modern Sur- 
gery. By Robert Druitt, Licentiate of the 
Poyal College of Physicians of London, Fellow of 
the Poyal Medical and Chirurgical Society, ete. 
New and Revised American from the Eighth En- 
larged and Improved London Edition, loithfour 
hundred and thirty-two illustrations, pp. -695. 
Philadelphia : Blanchard and Lea, 1860. 

Druitt's Surgery has been for a long time a 
favorite with practitioners and students, and 
perhaps no work has been so generally accept- 
ed by the colleges as a text-book. It is re- 



16 



REVIEWS AND BOOK NOTICES— EDITORIAL. 



Vol. V, No. 1. 



markably condensed, jet quite comprehensive 
and explicit, and is, as every book on practical 
subjects should be, well illustrated. 

Those familiar with the previous editions 
might not recognize the present re-issue, as 
it is enlarged one-third, and has added two 
hundred and fifty illustrations. 

The work has, by this new edition been 
brought up to the state of science of the times, 
as is evinced by the chapters on Intiammation, 
Pyaemia, Ophthalmoscopy, Excisions of Joints, 
Angesthesia, etc. 

The name of the American editor is, with 
propriety, omitted from the title-page, but the 
Americanizing of the work has been accom- 
plished in a manner which adds greatly to its 
value, and particularly to its acceptability in 
this country. 

Were this book not generally known to the 
profession, we would be induced to present its 
merits more at length, but a simple notice of 
its re-appearance, enlarged and improved, is all 
that is necessary in its favor. 



THE MEDICAL AND SURGICAL REPORTER. 



PHILADELPHIA, SATURDAY, OCTOBER 6, 1860. 



THE FIFTH VOLUME. 
With the commencement of this, the fifth 
volume, the Medical and Surgical Reporter 
appears in entirely new type, and considerably 
enlarged. The object of these changes is to 
obtain more room, to furnish its readers a larger 
amount and variety of matter, and to present 
it in a more pleasing and readable form. We 
have no unfulfilled promises to renew, nor any 
pledges to make. Independent in the fullest 
sense of the term, untrammelled by any school, 
party, clique, or publishing interest, uncompro- 
mising with whatever is opposed to the true ad- 
vancement of our profession, and, anxious to 
promote the advancement of science, we shall 
strive still more to deserve the success which 
we have already attained. 



THE STATUS OF AMERICAN MEDICAL 
LITERATURE. 

" Yv^estward the Star of Empire takes its way,'' 
is destined to be no less true in the literary than 
in the political world. He to whom the senti- 
ment was first attributed, spoke for England, 
her government and her people, little dreaming 
that the problem would be solved by a nation 



then unborn. While we would not claim too 
much for our country, we hold that it has given, 
and is giving evidence, that it can excel in some 
one or other, or all the departments of govern- 
ment, science, literature or art. The star of 
empire is now shedding its radiant lustre over 
our fair land, and we are still rapidly growing ' 
in political power and influence ; not by a na- 
tive growth alone, but, in spite of the broad 
Atlantic, by annually absorbing nourishment 
from the strength of the nations of the old 
world. And physical energy and power are not 
all that we compete with them in, or absorb 
from them. We have here a vast field for men- 
tal energy, and native talent is cultivating it 
nobly ; but Europe is contributing some of her 
talent, and will contribute much more, to aid 
us in laying the foundations of the empire of 
mind. She has already given us, in general and 
special science, such names as Agassiz, Audu- 
bon, Lieber, Dunglison and others. We thank 
her for these, and like the daughters of the 
horse-leech, still cry, "Grive, give." 

If all the foreigners who come among us 
were — which, of course, cannot be expected — 
men of intelligence and education, our advance 
in literature would be much more rapid than it 
is. But the foreign immigration is composed of 
a heterogeneous mass, and a large part of the 
material has to be molded into shape after it 
reaches our shores. This, with the fact, that 
the wave of civilization, which is constantly , 
rolling westward, encroaches upon the wilder- 
ness so rapidly, that its educational wants can- 
not be fully supplied, serves, so to speak, to 
make our institutions revolve with an unsteady 
motion on their pivot — education and intelli- 
gence. 

To meet the wants of our rapidly growing 
country, a great deal of crude material is neces- 
sarily sent forth from our schools and colleges. 
European travellers express surprise at the haste 
with which we dispatch our meals, as if we 
could not spare the time from business, tlmt is 
necessary to prepare our food for digestion by 
proper mastication. This is well founded, and it 
is to a certain extent true, of our educational i 
interests. The demands of our widely extended 



October 6, 1860. 



EDITOEIAL. 



17 



domain, which is so rapidly filling up, both by 
natural increase, and by foreign immigration, 
are so urgent, that really, our professional men 
cannot wait to become thoroughly educated. The 
literary meal must be swallowed with little re- 
gard to culinary preparation or succession of 
courses, and an active mind and a strong con- 
stitution, must be relied on afterward to digest 
it. 

But our nation is young and vigorous, and the 
national mind is untrammelled by any one im- 
practicable idea, that incubus which makes, as 
it were, a monomaniac of a nation, crushing out 
its energies, and hasting it on to imbecility, de- 
cadence and death. Like an unconquerable 
spirit, who, in spite of early disadvantages of 
education, is struggling upward to a respecta- 
ble literary standing, our nation is fast over- 
coming the numerous obstacles to her literary 
advancement, and is making rapid improve- 
ment in all the departments of science and lite- 
rature. 

Especially is this true of medical education. 
Whatever may be said of the inefficiency of 
our present system of medical education, the 
fact cannot be denied that it steadily advances 
.with the progress of time. It is more thorough, 
more systematic, and better adapted to the ne- 
cessities of the times and the spirit of the age, 
than that of twenty-five years ago would have 
been. Now, as imperfect as our system of 
medical education has been, we have furnished 
a large body of medical men, who, in point of 
literary and scientific attainments, would be a 
credit to any of the nations of the old world, 
and the proportionate number is annually in- 
creasing. 

Many of our literary productions take rank 
with the best foreign works on the same bran- 
ches, and there are departments of literature in 
which we excel. Indeed, the indications grow 
stronger and stronger, that our medical litera- 
ture will, ere long, be as eagerly sought by 
foreigners, as we, in times past, have sought 
their productions. We have active and gifted 
minds at work in the various departments of 
medical research, and the results of their labors 
will tend to elevate still more the literary claims 
of our country. 2 



As much, however, cannot be said of our 
periodical medical literature, which has strug- 
gled hard to attain an honorable position. It 
has been suffered to languish for want of pecu- 
niary and literary support, while we have been 
content to go abroad for this species of litera- 
ture. It will be worth our while to inquire 
into this matter a little, see where the respon- 
sibility rests, and place it there, and then in- 
quire whether there is any remedy, and what 
it is. And here we must regret the necessity 
of dividing the responsibility so much, as to be 
in danger of weakening the force of the appli- 
cation. 

First, then, publishers are responsible, who, 
instead of establishing journals on a firm, and 
independent basis, and offering a liberal remu- 
neration to the profession for literary contribu- 
tions, are content to appropriate the labors of 
our European brethren by republishing some 
of the prominent foreign journals, as the Lan- 
cet, the British and Foreign Medico-Chirurgical 
Eeview, and Braithwaite and Eanking, all of 
which circulate extensively in this country, 
and are a source of revenue to their publishers, 
while the material costs them little, or nothing, 
and not a thing is done to encourage American 
writers, or build up an American medical lite- 
rature. One or two publishing houses have 
pursued a different policy to a limited extent, 
and have attained a circulation for their jour- 
nals which affords them a small revenue. Our 
publishers have been blind to their own inter- 
ests in this matter. 

Second — ^the writers of our profession, th« 
physicians and surgeons, and the internes m 
our hospitals, the professors in our colleges, 
and practitioners generally, who lack the en- 
ergy and industry to record their observations, 
have had no small share in this responsibility. 
We will allow, that as a rule there has not been 
sufficient inducement offered them to spend 
much time in writing, or money, in the inves- 
tigation of subjects on which to write. Still, 
had they shown half the zeal and industry that 
were exhibited thirty years ago, by Chapman, 
Jackson, Horner, Eberle, Dewees, Mott, Fran- 
cis, and others, they would have done some- 
thing to maintain the character that those men 



18 



EDITOEIAL. 



Vol. V. No. 1. 



gave our periodical medical literature in tlieir 
day, and advanced tlieir own professional in- 
terests at the same time. 

Lastly — the profession generally is largely 
responsible in this matter. While they have 
liberally patronized foreign periodicals and 
their republication in this country, they have 
been slow to encourage a home literature, or to 
recognize true merit in journals published at 
their own doors. Thus, we have again and 
again seen meritorious, well conducted journals, 
perish for want of encouragement, when a little 
discrimination, and concentration of support, 
would have placed them on a basis that would 
have enabled them to do much toward deve- 
loping the medical mind of our country. 
Much money has been wasted in endeavoring 
to prop up evanescent publications, having 
-no object in view but the advocacy of the 
claims of some school, party, or publishing in- 
terest, while meritorious, independent journals, 
have been allowed to languish and die out for 
-want of support. 

But a brighter day is dawning on this de- 
partment of medical literature. It is asserting 
its claims to support, and those claims are 
being recognized by the profession, who are 
learning that Americans have ideas as well as 
foreigners, and that they can find an independ- 
. ent, untrammelled medical press, in which to 
give utterance to them. The day is not far 
d-istant when the republication of foreign me- 
^dical journals will be found to be a losing busi- 
ness, when, of course it will cease, and when 
■ organs of schools, parties, and other mere pri- 
vate interests will give way before an exten- 
sively patronized independent medical press, 
that will offer liberal inducements to original 
thinkers, and show to the old world that in 
;periodical medical literature, as well as in other 
things — "Westward the star of Empire takes 
its way." 

THE "CHEMISTEY" OF QUACKS, 

Several months ago, the Eeporter contained 

some remarks on a circular published by James 

C. Ayer & Co., in which the latter puffed up 

their "Ague Cure," and which circular fairly 



teems with "hyfalutin chemical nonsense." 
"J. C. A. & Co.," of course, do not attempt "to 
give the exact atomic weight of the substance 
employed." Now hear the reason why — ^which 
they publish in a letter to the editor of the 
American Druggist's Circular ! — Because they 
could not do so with perfect certainty. Honest 
quacks for once ! They insist now, however, 
not only that the term Utiwiinous bases, as used 
in their circular, is correct, but calling in aid 
one Alfred Booth, of Boston, who signs himself 
"Professor of Chemistry," that learned indi- 
vidual kicks up a tremendous chemical dust, 
out of which rise the " hituminous bases'' in 
splendid magnificence. Listen to his nonsence: 

"The exception to the term 'bituminous 
bases' is trivial; for any one who has mas- 
tered the rudiments even of the science would 
readily understand that the hydro-carbons were 
meant ; in fact, the terms may be considered 
synonymous. Cinchona, as is well known, fur- 
nishes two alkaloids, quinine and cinchonine — 
similar to, but not identical with, each other. 
Professor Silliman, of Yale College, says : ' In 
the preparation of these alkaloids, a portion of 
quinine is often obtained as an uncrystallizable 
resinous mass, which is, however, identical in 
chemical composition and medicinal properties 
with the crystalline base.' " 

Now, two things are certain : first, that 
"Professor" Booth, when he speaks of "biiu- 
minous bases," means the ^^hydro-carbons ;" and, 
secondly, when he speaks of Ayer's Ague Cure, 
he means an " uncrystallizable resinous mass,^' 
which is identical in chemical composition and 
medicinal properties with the crystalline base; 
i. e., quinia and cinchona. 

It is evident, hence, that this celebrated Pro- 
fessor Booth speaks of quinia and cinchona — 
which are vegetable alkaloids, containing 
nitrogen, as of bituminous bases ; i. e., hydro- 
carbons. This Booth, in quoting Silliman, does 
not even know that ^^ resinous," as applied to 
the uncrystallizable mass obtained in the pre- ( 
paration of the alkaloids of cinchona, only re- 
fers to the physical, tangible properties of this 
residue, and by no means to its chemical compo- 
sition, and, ignoramus as he is, he calls the un- 
crystallizable, resinous-looking alkaloids, con- 
taining nitrogen, hydro-carbons 1 sancta sim- 
plicitas ! 

0, most learned Booth ! — ye type of ye glo- 
rious chemical quacks ! 



October G, 1800. 



EDITOEIAL. 



19 



MORTALITY STATISTICS. 

Witli this number we commence tlie publica- 
tion of a regular weekly mortuary report of 
some of the principal cities throughout the 
Union. Those who have worked attstatistical 
tables of this kind, will understand the diffi- 
culty under which we labor, and be all the more 
ready to excuse any short-comings, which, for 
a little while, are unavoidable. The reports 
reach us in all shapes, and to get them into a 
uniform table requires a great deal of labor. 
We hope in a few weeks to have all the columns 
filled. We shall accompany the table every 
week with such remarks in the editorial col- 
umns, as shall suggest themselves ; and for any 
information, as to the health of different sec- 
tions, or other suggestions, we shall be much 
obliged to sanitarians throughout the country. 

No severe epidemics seem to prevail in our 
larger cities. Diphtheria is still prevailing in 
New York, and within a week or two, cases 
have been more frequent in Philadelphia. New 
York sustains her reputation for a fearful infant 
mortality. The percentage of deaths in that 
city, under five years, during the week ending 
September 22 d, is 55.21 ; in Philadelphia, 
47.34; in New Orleans, 34.90; in Charleston, 
32.35. 

In reference to the question now agitated, 
whether one or two sessions should be held in 
the public schools of this city, one of our daily 
papers appeals to the medical profession to give 
a decisive opinion on the subject. One session, 
with a recess of half an hour, giving the chil- 
dren an opportunity to devote the afternoon to 
bodily recreation and preparatory study, is 
enough for all purposes ; every hour spent 
in a second session, only tends to cripple the 
children bodily and mentally. 



The Philadelphia College of Pharmacy. — The 
Introductory Lecture to the course was deliv- 
ered by Mr. Procter on Monday evening last. 
The regular course was commenced by Mr. 
Procter and Dr. K. P. Thomas, on Wednesday 
evening. This prosperous institution has, for 
the present session, a much increased attend- 
ance. 



€iixxt^aulitutt. 



DISHONORABLE MERCENARY ARRANGEMENTS BE- 
TWEEN PHYSICIANS AND APOTHECARIES. 

Philadelphia, October 1st, 1860. 
Messrs. Editors: — 

The manner in which a number of medical 
practitioners are in the habit of exclusively pa- 
tronizing some particular apothecary has often 
attracted my attention, and awakened my sus- 
picions in regard to its disinterestedness. At 
the same time the professional character of 
some of those who are certainly in this habit, 
would seem to exonerate them from such sus- 
picion. 

Were the apothecaries, who are the sole reci- 
pients of the favors of those to whom I allude, 
the best to be found and most deserving of pa- 
tronage, or had they any peculiar preparations 
which could only be obtained from their estab- 
lishments, there might appear to be some rea- 
son in extenuation of the practice. But my 
attention, which has been lately attracted to 
the subject, has confirmed me in the opinion 
that the contrary is indeed the fact. 

I had often heard of a speculating collusion 
between physicians and apothecaries, and have 
long had sufficient evidence of its existence, to 
some extent ; but it is only lately that I have 
been led into enough exploration of the matter, 
to convince me that the vice exists to such an 
extent, and among so apparently respectable a 
class of practitioners, as to need the most tho- 
rough censorial investigation. There are drug- 
gists who make but little concealment of the 
practice, and there are practitioners whose 
prescription patronage is offered to the highest 
bidder. The arrangement appears to be an 
agreement by which the physician sending a 
prescription to an apothecary, receives from the 
latter a percentage on the amount paid for it. 
This percentage seems to vary from fifteen to 
fifty per centum of the receipts. 

The inducement, therefore, of the physician in 
such an agreement, is to get as much money 
into the hands of the apothecary as possible, 
so that he may increase his own share of it. 
With this object he prescribes as much and as 
often as possible, giving large doses, and chang- 
ing the remedy frequently. An eight, or twelve 
ounce mixture, in which a grain or two of the 
tartrate of antimony is dissolved, and flavored 
with a bitter tincture, is a favorite prescription 
with a practitioner in extensive practice in the 
upper part of this city, and who receives almost 
a moiety of the amount paid for it by the pa- 
tient. It can well be imagined that such a 
course may be profitable to both physician and 
druggist. 

The plea of those medical men, who are given 
to this vice, would perhaps be that many of 



^0 



CORRESPONDENCE. 



Vol. V. No. 1. 



their patients do not pay them for prescribing, 
and that only by extortion in charging for the 
medicine, to secure which cash must be paid, 
can they be compensated for their services. 
Such, in the state of affairs which thej have 
themselves brought about, may be the case, but 
the remedy is in their own hands. They have 
only to refuse attention to those who do not 
compensate them, and who are not proper ob- 
jects for professional charity. But the specu- 
lative collusion between the physician and 
druggist, tends to increase the unfortunate 
habit of not compensating physicians, because 
the former becomes indifferent about demanding 
a fee, while he is certain of eventually get- 
ting something from his well-drugged patient, 
through the intervention of the latter. 

Its oppressive effect on the poor and suffer- 
ing patient, who seeks relief from his afflictions 
by an appeal for professional charity, and then 
has his last pennies extorted for a prodigious 
drench of slop, is too contemptible for any 
association vdth a calling, which claims to 
have the relief of human suffering for its object. 

Perhaps the practice is confined to certain 
localities of the city ; my own observation of it 
has been mostly confined to one rather subur- 
ban neighborhood. 

Every honorable physician will acknowledge 
how degrading to the profession is this disrepu- 
table truckling for lucre. It is already sus- 
pected, and openly hinted at in the community, 
and must, in becoming generally known, as it 
certainly will, be toward the profession the 
cause of an irreparable loss of confidence and 
respect. 

I appeal to every honest medical practitioner 
to aid in exposing and condemning, as unworthy 
of professional courtesy, every man whom he 
knows to be guilty of a dishonorable alliance 
with druggists, and to withhold from the latter 
the patronage of his own prescribing. 

To the Censors of medical and pharmaceuti- 
dai societies the subject commends itself, as one 
deserving their scrutiny. 

Esprit de Corps. 



TANNINE AS AN ANTIDOTE TO STRYCHNIA AND 
NARCOTIC IRRITANTS. 

[Dr. Patze, of this city, referring to a short 
article, published in the Reporter, a few weeks 
since, writes to us as follows :] 
Messrs. Editors : 

The recommendation of tannic acid, as the 
surest antidote in poisoning with narcotic alka- 
loids (morphia, etc.) by Foulmouch and Meu- 
rer, induced Liidicke to use it in poisoning with 
strychnia, and with eminent success. Allow me 
to add a few cases to those already on record. 

While practising in New York, I was called 
to see a little boy four to five years of age. I 
found him in a peculiar state of excitement, his 



cheeks suffused with a circumscribed redness, 
his eyes unusually bright, reddened, and moving 
in a staring manner ; now jumping from his- 
couch, as for a pursuit, then cowardly crawling 
under his coverings : the skin dry, moderately 
warm, pulse somewhat accelerated, but slower 
than miglt be expected, considering his general 
excitement. He had very vivid delirium, talk- 
ing of his horses, dogs, as if he were in hot 
pursuit or running away from them. With 
some difficulty it was ascertained that he had 
eaten stramonium seeds. With cold fomenta- 
tions to the head, and two grains of tannin at a 
dose, repeated every half hour, or hour, he re- 
covered very rapidly. 

Some years ago, at Stettin, in Prussia, I was 
called to see a little girl between three and four 
years of age, whom I found in a very alarming 
condition ; the face red, foaming at the mouth, 
stertorous breathing, violent convulsions, inces- 
sant lateral motions of the spine ; pulse rather 
slow and full. It was soon ascertained that the 
child had been eating freely of the berries of 
solarium nigrum. An injection of warm water 
and vinegar was at once given, and tannin ad- 
ministered internally in two grain doses. The 
effect of this was surprising. The next morn- 
ing the child was out of danger, and a few days 
later, under derivatory treatment on the intes- 
tinal canal, she was perfectly restored. 

Permit me here to call attention to the pecu- 
liar effect which acrid narcotic poisons seem to 
have upon the motary spinal nerves, producing 
a snake-like movement of the body. In a case 
of poisoning by belladonna, which I witnessed, 
this winding motion of the body was extremely 
well marked, presenting a horrid spectacle. 
The same movements were present, though not 
in so violent a degree, in the cases above re- 
lated. A. Patze. 



EUROPEAN correspondence. 

Glasgow, September 11, 1860. 
Editors of Medical and Surgical Reporter : 

GrENTLEMEN : — In my present letter, I shall 
make a few observations upon the existing con- 
dition of the medical professioQ in England. 
There is not, as with us, one class only of medi- 
cal men, who alone are recognized as regular 
practitioners; but, instead of that, there are 
three or four grades, to only one of which the 
title of M. D. is annexed. This unnecessary 
subdivision causes confusion and jealousy, and 
many are in hopes that a simpler system will, 
before long, be adopted. 

What may be called the lowest grade, con- 
sists of those who have the license of the 
Apothecaries' Hall. These are called Apothe- 
caries ; but, instead of confining themselves to 
Pharmacy, they practise medicine, and have a 



October 6, 1860. 



COERESPONDENCE. 



21 



legal right to prescribe and to charge for their 
prescriptions. 

This strange state of affairs arose from the 
circumstance of the comparatively small num- 
ber of Doctors of Medicine, and their high scale 
of charges, which caused most persons to con- 
sult Apothecaries in slight cases of sickness. 
In former times, the Apothecary, although he 
might prescribe, had no right to charge, and he 
therefore was obliged, in order to obtain a fair 
remuneration for his trouble, both to give a 
great deal of medicine and to charge very high 
for it. But the evil bore in its own nature the 
germs of a remedy. 

From having so much practice thrown into 
their hands, they very naturally adopted a 
higher standard. By degrees, they have come 
to be a recognized body, and are no longer 
obliged to overdose, or pretend to do so, in order 
to get their fees. A regular examination in 
Medicine, as well as in Pharmacy, must be under- 
gone to be admitted into their ranks. 

The Surgeon, as the term is employed in 
England, means a man who has the license of 
the College of Surgeons. The studies for this 
diploma, if it may be so called, are usually car- 
ried on in some hospital, and in a school con- 
nected with it, which school has itself no power 
of conferring any degree whatever, but serves 
only to prepare the student for the examination 
by others than its own professors. 

The great mass of the practitioners of Eng- 
land have the diplomas of both the Apotheca- 
ries' Hall and of the College of Surgeons. They 
are called " General Practitioners." 
^ A still higher grade is formed of the Licen- 
tiates of the College of Physicians, and to these 
the title of Doctor or Physician is given, al- 
though they have no right to add"M. D." to their 
names. This right belongs solely to the gradu- 
ates of a University — that is, of Oxford, Cam- 
bridge, or of University College, London, and 
their number is consequently very limited, al- 
though the M. D.'s of Scottish or Irish Univer- 
sities are also recognized. In Scotland, the 
Universities of Glasgow, Edinburg, and Aber- 
deen, can confer the degree, and in Ireland it is 
conferred by Trinity College, Dublin, and by the 
Queen's University, which has Colleges at Cork, 
Limerick, and Belfast. In Scotland, the same 
constitution of the medical profession does not 
exist — at least, not to the same extent ; for a 
much greater proportion of the practitioners 
take the degree of M. D, from some one of the 
Scottish Universities. 

A peculiarity worth mentioning in the con- 
stitution of the profession in England, is, that 
t\iQ M. D.'s have no legal right to charge for 
their services, and instead of sending a bill at 
the end of a year, or six months, they are paid 
at _ every visit, the regular charge being a 
guinea. In the country, however, I heard of 
one instance in which a physician visited even 
at a distance for much less. The fact was men- 



tioned in a manner which showed that the ac- 
tion was considered unprofessional. 

I shall now give a brief account of one of the 
Scottish Universities, viz : that of Glasgow. It 
is a large building, built in a very ancient style, 
in three quadrangles, and contains a number of 
lecture rooms, some of which are devoted to 
medical lectures exclusively. This was not the 
case in one of the Queen's colleges which I 
visited in Ireland, where lectures on Logic, 
Latin and Surgery were delivered in the same 
room. The professorial chairs are, as far as 
relates to medicine, divided just as in the Uni- 
versity of Pennsylvania, with the addition of a 
chair of Botany, and one of Forensic Medicine. 
There is also a Waltonian lecturer on the eye, 
William Mackenzie, who is also a surgeon of 
the Glasgow Eye Infirmary, and with whose 
name all your readers are of course familiar. 

The chair of Natural History, in the Univer- 
sity is ably filled by Henry D. Rogers, LL. D., 
a brother of the distinguished Professor of Che- 
mistry in the University at home. 

First in the list of officers of the Institution 
comes James, Duke of Montrose, Chancellor. 
There is also a rector, the Earl of Elgin. These 
offices are not much more than nominal, in- 
deed, I was informed that the whole duty of the 
Chancellor consisted in delivering an address 
at stated intervals. 

I visited in the University the Hunterian 
Museum, (that of William Hunter.) It is of 
considerable size, and additions are from time 
to time being made to it, particularly in the 
department of embryology. The strictly me- 
dical portion of the museum is in the basement 
of the building appropriated for it, while on the 
main floor, there is that part relating to Com- 
parative Anatomy, interspersed with curiosities 
of various kinds, such as old books, old paint- 
ings, &c. I saw the cabinet of Materia Medica 
of the Professor of that branch, but it was very 
insignificant and not worthy of notice. 

What interested me more than the Univer- 
sity was the Hospital, or (as it is called) the 
Glasgow Royal Infirmary, which contains 600 
beds, and to which a large additional building, 
now in process of erection, will soon be added. 
It is a large stone building, five stories high, 
but inside, the favorable impression made by 
the handsome exterior, is, in a great measure, 
done away with, for the entries are narrow and 
the wards are rather crowded. I was surprised 
to find that patients with contagious diseases 
were received, although kept in a separate part 
of the building from the other patients. This 
part of the house the physicians distinguish by 
saying it is for the fever patients ; for although 
the distinction between typhus and enteric 
fever is beginning to be recognized even here, 
yet in ordinary conversation the term fever 
means typhus. 

A new thing to me in the Hospital was the 
lecture room for post mortem examinations, a 
room which would contain one or two hundred 



22 



COERESPONDENCE— NEWS AND MISCELLANY. 



Vol. V. No. 1. 



students. I saw there a printed abstract for 
the guidance of the student in making post 
mortems, which was headed "Pathological 
Eeport," and had printed on it the name of all 
the parts which it would be at all necessary 
usually to examine, with blank spaces opposite, 
to be filled up by the description of the case 
under examination. 

I noticed in the Hospital only one case of 
interest among the few that were shown to me. 
This case was one of excision of the head of 
the femur for anchylosis. After the operation 
great difficulty had been found in preventing 
protrusion of the end of the femur, and it had 
only been overcome at last by restoring the 
limb to its former bent position, making coun- 
ter-extension at the perineum, and extension by 
means of a heavy clock-weight attached by a 
rope to the knee, the rope passing over a 
roller on the side of the bed. Abscesses were 
burrowing down the thigh, and had been 
opened in several places, but I was told that 
the man was in better condition than before the 
operation. 

The next letter I shall send to you will pro- 
bably be from Edinburg. 

Very truly, yours, 

M. D. Abroad. 



NEWS AND MISCELLANY. 

Distinguishing Blood-Stains. — Before the coro- 
ner's jury in the recent murder case in this city. 
Professor Leidy gave the following testimony, 
which will be read with interest : 

September 28th to October 1st — Made numer- 
ous examinations of blood stains on a piece of 
oilcloth, and other substances, submitted to 
me September 27, by officer Schlemm, at the 
request of Mr. Mann. 

Repeated microscopic examinations of the 
stains exhibited many of the peculiar corpuscles 
which characterize blood. 

Made a number of microscopic measurements 
of the blood corpuscles of the blood stains. 

The blood corpuscles had the circular dis- 
coidal shape, and the structure of those of 
man and other mammals generally. 

By comparison with my own blood, dried and 
treated in the same manner as the stains, the 
blood corpuscles of the latter were observed to 
correspond with those of the former, in shape, 
structure and measurement. 

Too much importance, however, should not 
be given to these facts, as has been by high 
anatomical authorities, for the blood corpuscles 
of the horse, ox and hog, closely resemble those 
of man, and differ only in being smaller. Those 
of the dog are also of the same shape and struc- 
ture, and even closely approximate in size the 
blood corpuscles of man. 

The blood of a chicken, in the fresh state, ex- 
hibited the oval discoidal corpuscles longer 



than those of man, and containing an oval un~ 
cleus. The chicken blood, dried and treated in 
the manner of the blood stains, exhibited none 
of the characteristic oval corpuscles. These 
had all ruptured in the drying and subsequent 
solution, but their nuclei remained unbroken. 
The nuclei were exceedingly abundant, oval, 
and about half the size of the blood corpuscles 
of the stains and of my own blood. Excepting 
these small oval nuclei and some fat globules 
of no definite size, no corpuscles were observed 
in the dried chicken blood resembling those of 
the blood stains. 

A number of flattened oval bodies, of variable 
size, mingled with the blood stains, and bear- 
ing a general resemblance to the corpuscles of 
chickens and other bird blood, by treatment 
with iodine, turned blue, thus proving to be 
starch granules, prevalent everywhere as a con- 
stituent of dust. No other bodies, resembling 
the blood corpuscles of chickens' blood observed 
in the blood stains. 

Several small grey and brown hairs, mingled 
together with dirt in the blood stains, proved, 
on microscopic examination, to be hairs of the 
horse. No feathers or hairs, like those of 
chickens, nor hairs like those of man, were ob- 
served mingled with the blood stains. Some 
small pebbles and chips, with the blood stains, 
were treated with water. The solution by boil- 
ing emitted the odor of blood, coagulated in 
part, and assumed a dirty, gray appearance ; 
solution of potass dissolved the coagula, and 
the resulting liquid presented a red color, by 
transmitted light, a greenish hue by reflected 
light. This double color has been considered 
as one of the peculiarities of blood. 

Inferences. — That the blood stains strongly 
resemble, in their constitution, those of human 
blood ; the blood of the dog, the hog, the ox, 
or the horse ; that the blood stains bear com- 
paratively little or no resemblance to those made 
by the blood of the chicken or other birds. 



Physical Education. — There is no better evi- 
dence of the attention which is now being given 
to physical education, among the refined and 
intelligent classes, than is presented in the 
gymnastic establishment of Messrs. Hillebrand 
and Lewis, in this city. Both sexes, and persons 
of all ages, from almost infancy to advanced 
years, whether enfeebled or vigorous, are, by a 
progressive system of exercise, developed to a 
physical condition which cannot be otherwise 
obtained. 

A visit to the institution during the exercis- 
ing, will convince any one of the practicability 
of the means presented for training the body to 
the hiffhest state of health. 



Disease may be defined as a perversion either 
of the functions, or of the structure of the body, 
or of any of its parts. — Hartshorne's Memoranda 
Mcdica. 



October 6, 1860. 



NEWS AND MISCELLANY. 



23 



Consumption of Alcohol. — At the recent meet- 
ing of the American Pharmaceutical Associa- 
tion, Mr. Frederick Stearns, of Detroit, Mich- 
igan, submitted a paper on alcohol, stating that 
the Ohio River Valley contributed the largest 
share of whisky and its derivatives produced 
in the United States. The amount of whisky 
which finds a market annually in Cincinnati, is 
about 500,000 barrels, worth on an average, one 
year with another, $5,000,000. An estimate of 
the total product of whisky in the United 
States, based upon its production in the several 
States, and not upon the receipts of the large 
Eastern market, gives 1,500,000 barrels. The 
total product of alcohol in the United States, is 
184,000 barrels, worth over $7,000,000. Of this 
quantity one-fourth is manufactured in Cincin- 
nati. The manufacture in that city has, how- 
ever, fallen off at least one-half, since 1858, 
when it reached its maximum, owing to the 
foreign demand, which has been nothing since. 
It is estimated that, until the introduction of 
illuminating coal oils, by far the largest pro- 
proportion of the common alcohol produced, 
was employed in the manufacture of burning 
fluid ; since, however, the largest proportion is 
employed under the name of pure and proof 
spirit, in the manufacture of domestic brandy, 
gin, etc. 

In the remarks that followed upon this paper, 
a statement was made, which was corrobated 
by several members, that in making Catawba 
brandy, instead of its being distilled from 
Catawba wine, as is generally supposed, the 
mare, consisting of seed, skins and pulp, is 
placed in a still with ordinary whisky, and dis- 
tilled, and constitutes the Catawba brandy of 
Commerce. Catawba wine is $1.50 per gallon, 
and to produce the brandv from it would cost 
from $6 to $8, while it is offered at from $2.50 
to $4 per gallon. 



A Learned Doctor. — A correspondent of the 
Nashville Journal of Medicine and Surgery, 
writes as follows : 

_ Below you will find a prescription, or rather 
directions for taking one, which, if you see 
proper, you may publish for the edification of 
the million. The author is one who makes 
great pretensions to medical learning; cures 
consumptions, cancers ; knows more than any 
one else ; claims to be a regular practitioner. 
I send you a perfect copy, retaining the origi- 
nal in my own possession : 

" put the powders in to a quort of good whis- 
key take about a table spoon full at atim morn- 
ing before eatin before Diner at twelvand before 
Super when half out ad a pint more of whiskey 
then use all up thes Drops take a tea spoon ful at 
atim niorning and night if ther is more than 
too axions on the bowels aday tak less of the 
biters Regulate the doas by the bowels dite 
eat what ever will a gree with the stumark 
keep the bowels regular. Jan. 25, 1860. 

"Dr. W. 0. Gray.'^ 



Singular Death hy Bees. — From Lautschin, in 
Bohemia, we hear that, on the 14th of August, 
the funeral of a man took place who had been 
stung to death by bees. The deceased was a 
landed proprietor in Itzbic, about thirty years 
of age, and, while intoxicated, staggered against 
his bee-hives. The indignant bees swarmed 
out by thousands, and completely enveloped 
him from head to foot ; nor did they cease 
stinging him until life was extinct. In order to 
remove the body from the neighborhood of 
these hives, recourse was had to a hand engine 
to prevent the further onslaught of the bees, 
and the people were obliged to put on the 
clothes they wear when taking the honey from 
the hives, in order to preserve themselves from 
the fury of the enraged insects. Nor would 
they relinquish the corpse even of the unfortu- 
nate man, until they and it were drenched with 
water from the engine. The bees were so infu- 
riated that not even birds and other animals 
escaped their wrath ; dogs howled with pain, 
and terrified chickens and geese, screeching 
with pain, flew high in the air. 



Cure for Burns. — Dr. Franchino, in the Gazetia 
Medica Italina, states that the application of 
cherry laurel water to burns, cures them with 
great promptness. Among other advantages, 
it possesses that of suppressing the pain almost 
completely, of calming the agitation, the heat, 
etc. M. Franchino mixes it in proportion of 
eight parts to a hundred, with solution of gum 
arable, and applies compresses soaked in this 
mixture, upon the burnt surface, after having it 
previously cleaned, and the phlyctenge pierced. 
In order to renew the dressing, the compresses 
must be softened before their removal, by cov- 
ering them with other compresses soaked in 
water. 



Curious Case of Monomania. — The following, 
if not a canard, is a curious case of monomania : 

A citizen of Berlin, a man in comfortable cir- 
cumstances, is periodically attacked with a de- 
sire to knock off hats. He afterwards makes 
up the loss to the astonished victim of this 
strange fancy by the payment of three thalers. 
According to the calculation of his family, in the 
past year he has been obliged to make good the 
loss of two hundred and sixty-seven hats. At 
a recent musical festival, fifty-three hats were 
sacrificed to this curious frenzy, and for the 
evening's entertainment he paid a hundred and 
fifty-nine thalers. 



Dr. Reese's Course on Medical Chemistry will 
soon commence, embracing about forty lectures. 
They are to be delivered at the rooms. No. 915 
Sanson! street. In addition Dr. Reese proposes 
giving a course of practical instruction in the 
Laboratory, including toxicology. Applications 
may be made at the Laboratory of Booth, Grar- 
rett & Reese, No. 10 Chant street, Tenth below 
Market. 



24 



NEWS AND MITCELLANY. 



Vol. V, No. 1. 



Mr. WJiarion Jones' Stereoscope for Single Pic- 
tures. — Tlie Medical Times and Gazette says, that 
this is a very important and interesting dis- 
covery. An ordinary binocular opera glass can 
be fitted with the stereoscopic glasses. In a 
landscape thus viewed, the objects represented 
are all taken in by the two eyes at one glance, 
and appear to stand out in their relative posi- 
tions and distances, while the horizontal reces- 
sion of the distance toward the horizon is very 
evident. The amount of stereoscopic eflfect 
thus given is sufficient to impart to the picture 
much of the appearance of reality which the 
real scene, viewed with the two eyes, would 
have presented ; for, in pictures, the objects are 
commonly represented as seen at some distance, 
and could not, therefore, have appeared in na- 
ture to the two eyes in much stronger relief. 



EutJianatopsis . — The late Dr. Theophilus 
Thompson, in the following beautiful language, 
concludes his Clinical Lectures on Consump- 
tion: 

"Am I passing beyond becoming bounds in 
suggesting the reflection that, while witnessing 
such transitions from languor and decay into 
undying life, we may ourselves realize the truth 
that death is not the end of existence ; that it is 
something grander than human skill defeated ; 
that when art can do no more, and ' friends 
weep at the vestibule as the spirit passes out of the 
door,' we may win glimpses of brighter scenes, 
where the cares and passions of this lower life 
shall cease to engross, and the germs of open- 
ing science shall expand into the fulness of in- 
finite truth." 



Velpeaii's Opinion of Acupressure. — The Parisian 
correspondent of the Lancet says, that at a re- 
cent meeting of the Academy of Medicine, Vel- 
peau stated that he considered acupressure "an 
uncertain means of arresting hemorrhage, and 
that it would never supercede the ligature, al- 
though he readily admitted the imperfection of 
the latter means, and thought it most advisa- 
ble, when possible, to avoid the presence of a 
foreign body in the wound.'' 



Clinical Instruction in Bellevue Hospital, New 
York, has, by order of the Commissioners, been 
made free to students, almost at the same time 
that a similar course was adopted by the 
Board of the Philadelphia Hospital. This 
makes all the Hospitals of New York accessi- 
ble to students free of charge. It is, we think, 
high time that the Pennsylvania Hospital 
should follow. 



Illegitimacy in Scotland. — In the Lochee district 
of the Parish of Dundee, a considerable part of 
which is rural, 47 births were registered during 
the quarter ending June, of which 12 were ille- 
gitimate, being at a rate of 25 per cent. This 
is the highest rate of illegitimacy which the 
Scotch returns show. 



Year Book of Americayi Contributions to Medical 
Science and Literature. — We call attention to this 
work, the programme of which was published 
in a previous number, tt is to be edited and pub- 
lished by Dr.O.C.Gibbs, of Frewsburg, Chautau- 
qua County, N.Y. Those who wish to secure the j 
work, soon to be issued, if sufficient encourage- 
ment is given, should not hesitate to send in 
their subscription, (3 dollars.) Dr. Gibbs' emi- 
nent capacity for this kind of medical litera- 
ture, is too well known to need any enconium 
on our part. 



Cod-liver oil holds, at the present time, a very 
high place in the list of analeptics. All medi- 
cal observers are not of one opinion in regard 
to its value ; but most of them believe it (on 
the basis of experience in practice,) to be the 
best and most reliable (where it is tolerated) of 
all recuperative medicines ; not only in con- 
sumption, but in all other wasting diseases. — 
Hartshorne — Memoranda Medica. 



The Introductories in the medical colleges of 
this city will be delivered on Monday next, 
Sept. 8th, as follows : 

Uiiiverslty of Pennsylvayiia — Medical Department : 
Joseph Carson, M. D., Professor of Mat. Med. 
and Pharmacy; at 12 M. 

Jefferson Medical College. — Professor Dungli- 
soN, at 7J P. M. 

Pennsylvania College — Mediccd Department. — < 
Prof. Henry Hartshorne, at 5 P. M. 



The International Congress of Chemists held its 
twelfth annual session, at Carlsruhe, on the 4th 
of September. The proper means were discarded 
by which the application of a uniform system of 
atomic and molecular terms could be arrived at. 



Small mortality on the Western coast of Africa. 
— It would appear from the quarterly report of 
the head physicians of the French colony of 
Senegal, that during the last quarter, no death 
occurred at the hospital of St. Louis. 



Prof. E. M. Moore, formerly of Starling Medi- 
cal College, has been appointed to the chair of 
Surgery in the Buffalo School, made vacant by 
the resignation of Prof. Hamilton. 



Dr. P. J. Paterson, Superintendent of the 
Ohio Idiot Asylum, has been appointed Super- 
intendent of the Iowa Hospital for the Insane, 
at Mount Pleasant, Ohio. 



Dr. G. M. B. Maughs, of the Kansas City 
Medical and Surgical Review, has been apjDointed 
to the chair of Chemistry and Physiology in. the 
Missouri Medical College. 



I 



October 6, 18G0. 



NEWS AND MISCELLANY. 



25 



Dhsectmri Wounds. — At a recent meeting of 
the New York Medico-Chirurgical College, Pro- 
fessor Carnochan gave an account of his late 
sickness — a dissecting wound — contracted while 
making an autopsy on a dropsical patient, who 
had also suffered from ovarian troubles, the 
liver and some other organs being diseased. We 
give this interesting account as published in the 
American Medical Gazette for October : 

''The autopsy was made in some haste, and 
no opportunity was afforded for obtaining lard 
or oil for the protection of the hands. The con- 
tents of the abdominal cavity were still warm, 
though life had been some hours extinct. Hav- 
ing laid open the abdomen, and absorbed the 
accumulated liquids by sponges, the hands of 
the operator were passed into the cavity, and 
the diseased organs were sought out and exam- 
ined. The wound being sewn up, he washed 
his hands, and as he had not punctured them 
during the necropsy, nor could perceive any 
abrasion of the skin, he was not alarmed, when, 
in the evening of the same day, he felt the 
ends of his fingers somewhat painful. Next 
morning the forefinger was swollen, as if affected 
with felon. Still he would not believe that any 
trouble was to be apprehended, and no reme- 
dial measures were adopted. The inflamma- 
tion, however, spread, and the pain increased. 
The following day the malady seemed to be 
gaining ground, and in the evening the swell- 
ing extended to the wrist. He naturally became 
alarmed, and soaked his hand in ley, but it was 
too late ; the virus had been absorbed, and the 
symptoms continued to increase in intensity. 
The lymphatics became much enlarged, and 
the limb generally swollen. Irritative fever 
supervened, and suppuration commenced about 
the hand, accompanied with considerable hard- 
ness in the affected parts. He called in some 
of his medical friends, and after consultation, 
openings were made on the forefinger, the back 
of the hand, and higher up on the arm. The 
evacuation of the pus did not diminish the pain, 
but, on the contrary, seemed sometimes rather 
to aggravate it. After one of the incisions he 
became perfectly prostrated with agony, the 
digital nerve being probably in part divided. 
As the disease progressed he became typhoid, 
probably from the absorption of the virus, and 
was treated with brandy, quinine, and stimu- 
lants. Symptoms of pyaemia also appeared. 
The brain was stunned, and he remembers 
scarce anything for two weeks. By degrees the 
malady spent its force, and the pain began to 
subside ; but the amelioration was slow, and 
very different from that of ordinary traumatic 
lesion. The constitutional symptoms, also, 
slowly abated. 

Of the special points of interest in the case, 
one was the zymotic influence of the virus. It 
seemed to have a power of generating new mor- 
bific corpuscles, and propagated istelf in all di- 
rections with considerable rapidity. Thus the 
inflammation speedily invaded the whole of the 



hand, stiffening the fingers, so that fears were 
entertained that the use of that member might 
be entirely lost. Thence it spread upward 
through the limb, but happily it was arrested 
before invading with any considerable virulence 
the axilla, which was the principal seat of sup- 
puration in the recent lamentable case of Dr. 
De Sa, a young Brazilian physician, who recent- 
ly died at Paris from a dissecting wound in the 
thumb. 

After one of the incisions. Dr. Carnochan felt 
spasmodic twitchings in various parts of the 
body ; and the muscles, especially of the calf of 
the leg, contracted violently, causing much 
pain. The temporal muscles were also affected, 
and there was a consequent stiffness about the 
jaws, and a hardness about the zygomatic arch. 
These symptoms, which seemed initiatory of 
tetanus, happily soon passed away. In the 
case of Dr. De Sa no such spasms occurred, 
though he, as well as Prof. Carnochan, was so 
tormented with pain that sleep was impossible, 
except when procured by morphia or other nar- 
cotics. The pain resembled that of neuralgia, 
and was probably due, in part, to pressure 
made on the nerves, through the hardening 
and contraction of the exuded products of in- 
flammation poured around them. Hence, in 
proi^ortion as the nerves became accustomed to 
these new conditions, their abnormal sensibility 
was diminished, and the pain gradually became 
less intolerable. 

It is remarkable to how great a degree the 
state of health of the recipient controls the 
effects of dissecting wounds. In both the cases 
we have mentioned, and in nearly all others 
that have come to our knowledge, the infected 
constitution was suffering at the time from 
irritability or diminished health. Usually, 
also, the virus has been received from a recent 
subject. '^ 



Cold versus Heat. — The annual deaths by cold 
and by burns in this country follow a curious 
law of progression when their frequency is 
compared with the temperature of the year. 
Thus the temperature of 1855 v/as low, and in 
that year deaths by cold amounted to 195, and 
deaths by burns and sc'alds to 3,177 ; and in 
the year 1857, the temperature being high, the 
deaths by cold did not exceed 45, and by burns 
2,1 VI .—Lancet. 



Dr. Geo. T. Elliot has resigned his Lecture- 
ship in the College of Physicians and Surgeons, 
New York. 



^^ In consequence of an accident in the 
press, the publication of our last issue was de- 
layed, causing its distribution in this city and 
by mail to be irregular, for which we apologize 
to those concerned. 



26 



NEWS AND MISCELLANY. 



Vol. V. No. 1. 



ArmT/ and Navy. — Assistant Surgeon Thomas 
J. Charlton has been ordered to the Naval Hos- 
pital, Chelsea. 

Assistant Surgeon A. S. Grarnett has been de- 
tached from the Navy Yard at "Washington, 
and ordered to proceed by steamer of 5th Octo- 
ber from New York to Key West, and report 
for duty on board the United States steamer 
Wyandotte, as the relief of Assistant Surgeon 
Stewart Kennedy. 

Surgeon W. S. W. Euschenberger has been 
ordered to proceed to Norfolk, to report for duty 
on board the steam sloop Eichmond. 

Assistant Surgeon J. W. Sandford, Jr., has 
been ordered to proceed to Key West by 
steamer of 5th of October, to relieve Assistant 
Surgeon H. L. Sheldon, of the U. S. steamer 
Crusader. 

Assistant Surgeon J. Vansant, Medical De- 
partment, has been assigned to temporary duty 
llet Fort Daas, Oragon. 



Correction. — The "typos" last week made sev- 
eral ludicrous blunders, which escaped our 
proof-reader, but which, it is presumed, our 
readers corrected for themselves. Under the 
head of proceedings of "Philadelphia County 
Medical Society," remarks of Dr. Mayburry, at 
page 540, ninth line from bottom, in the first 
column, for ^'' considerations^^ read consideration, 
and in the following line for " cover^^ read occu- 
py. In the next column, on the same page, for 
^^tn utero" read in utero ; for "nitra-uterine^' read 
intra-uterine ; between "$500" & ^imprisonment" 
insert and ; for ''month's" read months; for ''pur- 
ticulor," particular; for ''osi uteri" read os-uteri, 
and for '■'tampen" tampon. The sentence begin- 
ning with "In" after the phrase "■ not exceeding 
three years" ought to be a new paragraph. 



%ns'ixizxs to ^orr^spoitU^ntj?. 

D. E. — Artificial leeches, of an improved con- 
struction, are made by the surgical cutlers in this 
city. They are not complicated or very costly, but 
practically we know nothing of them. They are 
probably not much in use. 

M. D. — The influence of freshly painted walls in 
producing lead poisoning in those sleeping in the 
rooms, though not well understood, has had evidence 
presented in its favor. An infant in the family of a 
medical practitioner in this city, some months ago, 
exhibited all the ordinary symptoms of lead poison- 
ing, as palsy, spasm of abdominal muscles, etc., 
after having occupied a newly painted room. If in- 
terested in the subject, we can refer you to the prac- 
titioner alluded to. 

E. R. — Refer to Hamilton's or Malgaigne's trea- 
tise on fractures, to the medico-legal works of 
Elwell, and Wharton and Stille, and consult a lawyer. 

Student. — Get from the college a list of text- 
books recommended, and send to the publishers for 
a price catalogue. 



DEATHS. 

Burton — In Lansingburg, N. J., of typhoid fever, 
on the 23d September, Dr. Casper Van Wie Burton, 
in the 51st year of his age. 

Dr. Burton was born in Albany, where his father 
still resides. He was a pupil in medicine of the 
accomplished Dr. Brinsmade, of Troy, and a gradu- 
ate of the Albany Medical College. 

For nearly twenty years he has resided in the 
beautiful village of Lansinghburg, on the Hudson, 
where he was born, extensively engaged in profes- 
sional life, and until a few days since, when he was 
seized with the malady which terminated it, in the 
very meridian of its vigor and usefulness. 

Dr. Burton was warmly devoted to his profes- 
sion, and maintained in it the position of an unas- 
suming gentlemen and an accomplished physician. 
He attained with his professional brethren the repu- 
tation of a judicious counsellor and a skillful prac- 
titioner. His nature was generous, social, warm- 
hearted, so that he was not only deservedly popular, 
but greatly beloved by the whole community in 
which he lived, and it unaffectedly mourns the great 
loss it has sustained in his death. " Truly may it 
be said of him, that an eminently good man has^ 
fallen." 

Of several children, the eldest is Dr. Nathan H. 
Burton, of Troy, upon whom may there rest the 
mantle of his father's virtues. h. D. W. 



Communications Received. — District of Colum- 
bia, Dr. G. M. Dove, (with end.)— /owa, Dr. W. F. 
Potter, (with end.,) Dr. J. H. West, (with end.,) 
Dr. Geo. Reeder, (with end.) — Indiana, Dr. L. D. 
Personette, (with end.) — Kentucky, Dr. C S. Abell — 
Louisiana, Dr. Benedict — 3Iississippi, Dr. J. W. Spill- 
man, (with end.) — New York, Dr. MacNicholl, (2,) 
Dr. Ormiston, (with end.,) Mr. C. T. Evans, Dr. J. 
B. Hayes, (with end.,) Dr. S. D. Williard, Dr. 0. C. 
Gibbs — New Jersey, Dr. Max Kuechler, (2,) Dr. R. 
M. Bateman, Dr. Thos. Johnson— OAto, Dr. C. 
Welch, (with end.,) Dr. P. H. Clark, (with end.)— 
Pennsylvania, Dr. R. Brown, (with end.,) Dr. A. P. 
Dutcher, Dr. J. Y. Shindle, (with end.,) Dr. Wm. 
Anderson, (with end.,) Dr. Robert H. Patterson, 
(with end.,) Dr. E. H. Pentz, (with end.,) Dr. L. 
Wachter, (with end.,) Dr. J. G. Duncan, (with 
end.,) Dr. E. R. Early, (with end.,) Dr. A. B. Dill, : 
(with end.,) Mr. W. E. Chapman — Tennessee, D. G. 
R, Schriven, (with end.) 

Office Payments— J)v. H. S. Jacoby, (Pa.,) Dr. B. 
M. Collins, (Pa.,) Dr. F. R. Gregory, Dr. Fonday, 
Dr. S. C. McCormick, (Pa ,) Dr. R. C. Hayes, (Pa.,) 
Dr. G. Y. Shoemaker. By Mr. Swaine: Dr. P. W. 
Russell, Dr. P. M Lyons. By Mr. Hulme : Drs. A. 
D. Markley, J. Lambert, J. G. Mensch, N. Apple- 
bach, S. R. Keeler, A. F. Shelly, S. J. Funk, B. C. ± 
Walter, F. A. Kitchen, A. Stout, W. F. Martin, H. I 
Riegel, W. E. Barnes, G J. Scholl, \N. H. Crawford, * 
G. Klinefelter, C B. Warrington, C. Sellers, J. H. 
Dickenshied, J. S. Shimer, S. R. Rittenhouse, W. 
Herbert, J. H. Helfrich, C. E. Shoemaker, J. Kern, 
G. S. Kast, D. K Shoemaker, J. G. Obi, A. A. Zie- 
genfuss, J. H. Wythes, R. C. Fruit, S. W. Trimmer, 
R. H. Tubbs, J. J. Rogers. 



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ADVEKTISEMENTS. 



Harris — At Baltimore, September 29th, Professor 
Chapin A. Harris, M. D. The Baltimore Patriot 
says: 

In the death of Professor Chapin A. Harris, sci- 
ence loses who had, in the particular branch to 
"which he dedicated his labors, no superior. He 
was born in Western New York, (Onondaga county, ( 
in 1806, graduated in medicine in 1829, the prac- 
tice of which, in a short time, he resigned, to devote 
himself exclusively to the science and practice of 
dental surgery. In this he had no equal. He 
raised that profession, both by his writings and ex- 
ample, far above the place it had up to this time 
held, through the neglect and ignorance of its prac- 
titioners ; and by his continued eflForts and his sci- 
entific developments, he gave it an honorable posi- 
tion. To that profession he is thoroughly well known, 
both by his writings and by reason of the fact that 
as chief of the Baltimore College of Dental Surgery, 
he has helped to instruct and form some its most 
useful members. Dr. Harris was not better known, 
though more widely, for these labors and qualifica- 
tions, nor more respected than he was tor an amia 
ble, hind-hearted disposition, and the most exem- 
plary virtues of private life. 

" Every If ember of the Profession should pos- 
sess a copy, even although he owns the 

original." — Brit. Am. Med. Jour. 

epito]nj:e; 

OP 

BRAITHWAITE'S RETROSPECT 

OP 

PRACTICAL MEDICINE AND SURGERY, 

By Walter S. Wells, M. D. 

Two volumes, large 8vo, (900 pages in each.) Sheep, $7. 

"It deserves the patronage of the Profession." 
"It is worth ten times the money." 
"It is a condensed Medical Library." 

So say the Medical Journals. 

Hundreds of the leading physicians, in various parts of the 
country, who have subscribed to this work, (without exception,) 
unite their testimony to its value, as 

"A REMEMBRANCER AND MENTOR." 

The Publisher would r^fer the profession to the various medi- 
cal journals for more extended and favoi able noticen, and would 
be pleased to supply Prospectuses, &c., to any who may desire. 
Address the publisher, (Box No. 4553, Post Office.) 

CHARLES T. EVANS, 
No. 115 Nassau street, N. Y. 
Copies will be forwarded to any part of the United States, 
•within 3,000 miles, free of expense, by sending the price. 

Practical Course of Lectures and Bemonstra- 
tions on the Medicine and Surgery of the 
Eye and Ear. 

DR. TURNBULL will commence his regular course of Lec- 
tures and Clinical Demonstrations on the above subjects, 
at his house. 1208 Spruce Street, and at the Howard Hospital, 
1812 Lombard Street, about the middle of October, 1860. This 
course treats of the clinical use of the Ophtbalmoscope in its 
application to the diagnosis of obscure diseases of the eye. Al.-o, 
the use of the Otoscope in affections of the ear. Dr. T. has pro- 
vided himself with large and beautiful drawings, also, the 
celebrated models of "Auzoux" of the eye and ear for class 
demonstrations. 



TO PHYSICIANS AND DRUGGISTS.— A four story well- 
built corner property and drug store (an old stand,) cen- 
trally and pleasantly located^ in the city, with a good practice, 
will be sold for $7,500; $4 000 may remain on the property; or 
the store and practice will be sold for $1,200, and the propertj' 
rented for $500. By attention a good office practice may be se- 
cured, or the store made to do a good business. Satisfactory 
reasons will be given for selling. Letters containing return 
stamp promptly answered. Address M. D., care of Publication 
Office of the Medical and Surgical Reporter, Philadelphia, t.n.2 



LOMG ISLAND COLLEGE HOSPITAL. 

BROOKLYN, N. Y. 

I^HE COUKSE prelimiuary to the session of 1861, will begin 
on the 18th of February, and the Regular Lectures on the 
18th of March, to continue sixteen weeks. 

REGENTS. 
Hon. Samuel Sloan, Pres't. T. H. Rodman, Esq., Sec. 



COUNCIL. 



T. L. Mason, M. D., 
W. H. Dudley, M. D., 



C. L. Mitchell, M. D., 
J. H. Henry, xM. D. 



PROFESSORS. 

Austin Flint. M. D., Practical Medicine and Pathology. 

FraiNK H. Hamilton, M. D., Principles and Practice of Sur- 
gery. 

James D. Trask, M. D., Obstetrics, and Diseases of Women p.nd 
Cliildien. 

R. Ogden Doremus, M. D., Chemistry and Toxicology. 

Joseph C. Hutchison, M. D., Operative Surgery and Surgical 
Anatomy. 

John C. Dalton, M. D., Physiology and Microscopic Anatomy. 

De Witt C. Enos, M. D., General and Descriptive Anatomj'. 

Edwin N. Chapman, M. D., Therapeutics and Materia Medica. 

DEMONSTATOR OF ANATOMY. 
George R. Smith, M. D. 

Every facility afforded for dissection throughout the year. 

Vlinical Lectures daily, except Sunday, on BTedicine, Surgery 
and Obstetrics, for which ample material is furnished in the 
lying-in wards and general hospital under the same roof. 

Professor Flint will give careful instruction in Auscultation 
and Percussion, and the art of Diagnosis in general. 

Professor Hamilton, in his Regular Course, will dwell espe- 
cially on Dislocations and Fractures, and in his Preliminary 
Course, will give a series of Lectures on Military Surgery. 

As far as practicable, instruction in all the departments will 
be by demonstration. 

Feis. — Full Course, $100: Matriculation, $5; Demonstrator's 
Fee, $3; Graduation, $25. 205 



PRACTICAL COURSE OF 

INSTRUCTION IN URINARY PATHOLOGY, 

By John W. Lodge, M. D. 
Dr. Lodge will commence a Course upon the above subject, 
about the 1st of November, to continue until the middle of Janu- 
ary, embracing a series of Twenty Lectures and Practical De- 
monstrations. 

The object of the Course will be to extend an opportunity to 
those desirous of becoming familiar with the Chemical Physiology 
of the Urine, its various Pathological Deposits, their Microscopic 
Characters, Diagnosis, and Therapeutical indications. 

Arrangements have been made by which specimens of the 
most important urinary deposits occurring in the several Hos- 
pitals of this city can be obtained. 

For further information, apply to 

DR. J. W. LODGE, 
No. 123 South Seventh Street. 
Fee for the Course, $5.00. 
Philadelphia, Sept , 1860. 



PHILADELPHIA SCHOOL OF ANATOMY. 

UPPER END OF COLLEOE AVENUE. 
■WIXTER ANNOUSfCEEENT. 

THE Rooms of this old established Institution, under the 
management of Dr. D. Hayes Agnew, are now open to stu- 
dents and physicians desirous of prosecuting their studies. A 
full Course of Lectures will be delivered on special and Surgical 
Anatomy, commencing about the 11th of October. 

The colleges leave it optional with the student where he takes 
out his dissecting ticket. 
Fee for the Course, $10. 

D. HAYES AGNEW, M. D., 
204 16 North Eleventh street. 



i 



THE 



MEDICAL AND SURGICAL REPORTER. 



WHOLE SERIES, 
NO. 208. 



} PHILADELPHIA, OCTOBER 13, 1860. { 



NEW SERIES 
VOL.V. I«0. 2. 



ORICBNAL DEPARTMENT. 

LECTURES. 

Lectures on the Crystalline Lens and its 
Diseases. 

Delivered at the Howard Hospital, 

By Laurence Turnbull, M. T>., 

Ophthalmic Surgeon to the Hospital. 

The crystalline lens lies immediately behind 
the iris, partially imbedded in the anterior sur- 
face of the vitreous humor, and is held in situ 
by the elastic suspensory ligament from the 
hyaloid membrane. In man it is a double con- 
reK lens. According to Petit, the diameter of 
the lens is about four or four and a half lines, and 
its axis two lines in length ; according to recent 
careful measurements, however, by Mr. Thomas 
Nunneley, of Leeds, England, the diameter is "SI 
to "36 of an inch, and its axis measures from "18 
to '22 of an inch. The axis of the lens is a line, 
drawn from the centre of its anterior surface to 
that of its posterior. The diameter is a line 

I drawn across from one point of the margin to 
the opposite, so as to divide the junction of the 
two surfaces. The posterior surface of the lens, 

I according to the same authority, is nearly, but 

1 not absolutely, a hemisphere; while the anterior 
is a segment of a much larger sphere ! it being 

I (fn this surface that the variations, at different 
ages in the individual, and in different creatures, 
take place much more than in the posterior 
»urface of the lens, a point of no little import- 
ance to the ophthalmic surgeon. 

The specific gravity of the human lens 

in man, is - - - - 1.1304 

The specific gravity of the human lens 

in woman, is, ... 1.0967 

' According to Chevenix the sp. gr. of the 

human lens, - - - . 1,0790 

3 



The recent lens is as clear as crystal, and is 
closely enveloped in a transparent, elastilc cap- 
sule. The density of the lens, increases from 
its margin to its centre, though apparently ho- 
mogeneous, its structure is like the cornea, 
when minutely examined, found to be most 
beautiful and elaborate. The body of the lens is 
capable of being separated into layers or lamellae, 
like the coats of an onion. These layers are, 
however, limited by certain determinate lines, 
which radiate from the centre, and pass from 
one surface or pole to the other. The primary 
number of these lines seems to be three. They 
occur on both sides of the lens ; those, how- 
ever, on the posterior surface, instead of being 
opposite to those on the anterior, lie between 
them. The laminge of the body of the lens ar« 
beautifully constructed of fiat-toothed fibres, 
laid side to side. This arrangement is remark- 
ably evident in the lens of the cod fish, in 
which it was first discovered. If the lens ie 
placed in boiling water, its outer portion at once 
becomes opaque, but the centre becomes lik« 
transparent horn. 

In order to examine the lens microscopically, 
it should be rendered opaque by boiling water, 
and hardened by alcohol and chromic acid, 
diluted with water. In the opaque lens the 
fibres have undergone degeneration ; they are 
broken up, and are granular. No vessels or 
nerves can be traced in the lens or its capsule, 
but during foetal life, and up to the period of 
birth, both contain vessels. 

The capsule is not affected like the lens by 
heat, alcohol, or chromic acid ; but the slightest 
puncture renders it opaque. It is so elastic, 
that when cut, it curls up ; in physical charac- 
ter it resembles the elastic layer of the cornea. 
It has a single layer of epithelial cells upon 
its inner surface. It is never absorbed like the 
crystalline lens, even if cut up by the surgeon's 
knife ; it simply curls up, and is removed 
often with much difficulty from the axis of 
vision, 

27 



28 



LECTUEES. 



Vol. V. No. 2. 



THE DISEASES OF THE LENS AND ITS CAPSULE. 

In childhood and youth the lens is almost 
free from color, but in old age it becomes of an 
amber hue. 

The lens is occasionally broken by violence 
and, thereafter, becomes absorbed ; or, if punc- 
tured by a sharp instrument, as a needle, the in- 
strument, in making the wound and causes opa- 
city of the lens, and admits the aqueous humor, 
which in time dissolves it and causes it to disap- 
pear. In cases in which this condition of things 
is suspected, by dilating the pupil with atropia 
and employing the " catoptric test,^' we can as- 
sure ourselves whether the lens is in place or not. 
When the lens is dislocated and presses against 
the iris, it is apt to be followed by general in- 
flammation of the eyeball. The case should be 
treated with the free application of ext. bella- 
donna and depletion ; if these means fail, the 
lens should be removed by a small incision in 
the cornea. 

Wounds of the crystalline lens are carefully 
treated by W. Cooper.* We shall quote two 
cases related under this head : 

*' F. M., aged eight, was brought to St. Mary's 
July 19th, 1858. On the previous day he was 
looking into the muzzle of a toy gun, which he 
had charged with a piece of wood having a 
meedle stuck in it, when the gun accidentally 
-.went off, and the needle entered the right cornea, 
near its centre, where it remained until pulled 
out. When I saw the eye there was a general 
sclerotic blush, and the iris, naturally gray, had 
a greenish tinge ; a hazy point on the cornea 
indicated the seat of the wound, and correspond- 
ing therewith was a hazy point in the capsule 
^ of the crystalline lens, close to the margin of the 
eontracted pupil. Simple treatment was adopted, 
and on July 26th the eye was quite free from 
^inflammation, the iris of a natural color, but 
: adherent to an opaque spot in the capsule ; the 
lens was perfectly clear, and I thought the case 
would be one of those exceptional instances in 
-which the lens escapes opacity, but I was mis- 
taken. After the lapse of a month, the sight 
became impaired, and an unmistakeable gray 
film occupied the pupil. This I watched, and 
saw it gradually increase in opacity, but very 
slowly, so that three months elapsed before 
traumatic cataract was fully developed; the 
opaque spot in the capsule remained unaltered; 
the pupil was disengaged by atropine." 

*'T. W., aged eight years and a half, was 
orought to St. Mary's July 31, 1858. A fort- 
* White Cooper on Wounds aod Iiyuries of the Eye, pp. 118, 118. 



night previously he was looking through a key- 
hole, when a boy on the other side thrust a 
pin through and wounded his right eye. There 
was much pain -f and the eye was poulticed with 
a mess, in which bruised snails formed an ingre- 
dient. The cornea now presented a wound near 
its centre, still open, and surrounded by a con- 
siderable haze ; the iris, naturally hazel, was 
dark, reddish brown, and in contact with the 
cornea ; the capsule of the lens was opaque, and 
the pupil, reduced in size and of a narrow cres- 
centic form, was adherent to it. There was 
much venous congestion of the conjunctiva and 
sclerotica, and a purple zone surrounded the 
cornea. 

" The child was feeble, and not in a condition 
to bear powerful treatment. Two leeches were 
applied, and gray powder, with sesquioxide of 
iron, administered twice daily : the eye to be 
frequently fomented with a belladonna lotion, 
and the brow to be rubbed with extract of bel- 
ladonna and opium. At the expiration of a weekj 
great amendment was visible. The vascularity 
had diminished, and the iris had, to a consid- 
erable extent, recovered its natural hue. The 
mercurial was, after a time, suspended, and 
quinine with iron substituted. The eye gradu- 
ally lost its inflammatory condition, but the 
pupil remained closed." 

All inflammatory action taking place in the 
lens produces opacity. By the term cataract 
we now understand opacity of the lens or its 
capsule, or both ; cataracts are divided into 
"lenticular and capsular, or capsulo-lenticular. 
Thus, in one eye we may have simply com- 
mencing opacity in the centre of the lens, while 
in the other eye we may have the full, ripe 
cataract, involving both capsule and lens. Still 
there are good authorities who deny that the 
capsule becomes opaque, as Stellwag,* of the 
Greneral Hospital of Vienna, who, after a careful 
examination of about fifty cataracts with appa- 
rently opaque capsules, states that in every in- 
stance the opacity was produced by matter at- 
tached to the lenticular surface of the capsules, not 
being deposited in the very tissue of the capsules 
themselves. Yet we see, frequently, eyes, in the 
congenital cataract of children, in which there is 
nothing but a white, chalk-like capsule remain- 
ing, the whole of the lens being ab8orbed,or after, 
the division of the lens by the needle, when the 
capsule has been cut up into shreds, it has lost 
all transparency. This may be the result of the 



* Die Ophthaliuologie, eta, 1853-8. 



October 13, 1860. 



LECTURES. 



29 



operation, but in the congenital cases there was 
no lens left. 

I like the term "Nuclear" and "Cortical," 
as suggested by Mr. Dixon, ■^- as very convenient 
to distinguish two grand divisions of cataract. 

" The nuclear form is that met with in old 
persons either alone or (much more frequently) 
in combination with cortical opacity. 

Under the head of cortical cataract would be 
arranged : — 

1. That congenital kind characterized by a 
single white dot, (cataracta centralis,) or cone, 
(cataracta pyramidata,) corresponding to the 
middle of the pupillary space. 

2. That rarer form, occurring both in child- 
hood and at adult age, which exhibits itself in 
irregular opaque patches on the anterior or 
posterior surface of the lens, and immediately 
within the cavity of the capsule. These have 
hitherto been described as opacities of the an- 
terior or posterior capsule itself. 

3. That. which is the most common cataract 
of middle age, and even of old age, commenc- 
ing as opaque striae at the edge of the lens, and 
thence converging along its anterior and pos- 
terior faces. 

The softening process, which sooner or later 
involves all cataracts, (or opacities of the lens,) 
is invariably cortical in its origin, the nucleus 
being always the last portion to undergo solu- 
tion." The two important marks for the (stu- 
dent) to keep in mind, as indicating the com- 
position of a cataract, are: — (1) striated, radi- 
ating opacity ; and (2) irregular patchy, or 
mottled opacity. The former always shows 
that the fibres of the lens still retain, to a 
certain extent, their natural arrangement, how- 
ever they may be here and there broken down, 
or otherwise changed, and mixed with granu- 
lar, earthy, or fatty matter. The latter appear- 
ance is a proof that the superficial fibres have 
been softened down into a pulp, and mixed up 
with the substances I have just enumerated. 
In congenital cataract, we have the same forms 
as in the adult, only on a more minute scale, 
and the most frequent form is that according 
to Mr. Dixon, in which the whole area of the 
pupil, in its natural state, is occupied by a 
grayish-white, faintly-striated opacity. The 
rarest form is that in which a limited deposit 
occurs among the cortical fibres of the lens on its 
anterior or posterior surface and in but one eye. 
In such a case, Mr. Dixon operated by kera- 

* Practical Study of Diseases of the Eye, by James Pizon, 
pp. 2\b-2\9.— English Edition. 



tonyxis, (or the operation for removing the cata- 
ract by solution, in which the needle is intro- 
duced through the cornea,) when the child 
was only six months old and the case did 
perfectly well. 

In the " nuclear or lenticular" form of cataract 
commencing in a lens previously healthy, the 
patient complains that all objects appear as if 
seen through a slight fog or cloud. This oc- 
curs more in the bright day-light, but at twi- 
light, when the light is moderate, the vision 
becomes distinct. 

The cause of this is owing to the reduction 
of the size of the pupil by the bright rays of 
light, causing the light to fall upon the dense 
central opacity. This form of cataract is much im- 
proved by the use of belladonna or atropia. There 
is also no injury resulting from its use even for 
years, as will be seen by the following case, which 
I extract from Mr. Dixon's work: — "A man, 
about forty years of age, has had cataract in both 
eyes from birth. The left lens is not only very 
opaque at its centre, but the peripheral portion 
is also slightly cloudy. With this eye he can 
discern large objects, but cannot distinguish 
type. In the right eye, the area of the pupil, 
while in its natural state, is also wholly occu- 
pied by a pretty dense opacity ; but when he 
uses atropine, a perfectly clear portion of lens 
is brought into view, and he not only is able to 
read, but to do the fine work of a watch 
finisher, adjusting even the delicate works of 
Geneva watches. He has used belladonna or 
atropine during the greater part of his life, 
without any impairment of the natural motory 
power of the iris having resulted."* 

The progress of the cataract is usually slow, yet 
in a case reported by Tyrrell, "the patient, 
who could on one morning read a moderate 
sized print, with tolerable ease, on the follow- 
ing morning could only distinguish light from 
darkness : the lens having become perfectly 
opaque in the interim. This case occurred in 
a gentleman of highly nervous temperament." 
In the early stage of this disease, some ad- 
vantage is gained by the use of glasses tinged 
blueish, black, or very dark green. 

In soft cataract, the most frequent appearance 
is that of a whitish, glistening surface, with a 
slight tinge of blue, closely resembling a mix- 
ture of milk and water ; sometimes the surface 
of the opaque body appears flocculent, like that 
of a recently-broken piece of spermaceti. 



* See a case reported in the Medical and Surgical Reporter, 
vol. IV., p. 537, in which occasional use of atropia was found 
yeiy beneficial. 



30 



COMMUNICATIONS. 



Vol. V. No. 2. 



The aspect of tlie fluid cataract is occasionally 
like that of cream, being white, with a very 
slight tinge of yellow ; when such form a of cata- 
ract is examined with a double-convex lens when 
the pupil is fully dilated, opposite a good light, 
the opaque body will then be found to project 
most at the lower part. 

The cortical or capsular cataract has a dense, 
white aspect, like unglazed paper, or the surface 
of an egg-shell of the common fowl ; it is to be 
distinguished from opacity of the lens by its 
greater density, by its want of any glistening 
appearance, and by its position, as it appears 
almost in contact with the pupillary margin of 
the iris. If the pupil be dilated and the whole 
capsule is affected, it has a uniform character 
without flocculi or radii. Tyrrell also remarks 
that he does not recollect to have seen even 
partial disease of this kind, independent of dis- 
ease of the lens, excepting when congenital. 

Diagnosis. — The symptoms of cataract, says 
Mackenzie, as indeed of all diseases, are subjec- 
tive and objective ; that is to say, they consist 
either in certain feelings which the patient expe- 
riences, as impaired vision, headache, giddiness, 
&c., or in certain changes which the observer per- 
ceives in the form, color, texture, consistency, 
vascularity and mobility of the different parts 
of the organ of vision. Both sets of symptoms 
will require to be very closely examined in sus- 
pected cases. 

4»»^* 

COMMUNICATIONS. 

Tlie Present State of Ophthalmoscopy. 
By Max Kuechler, M. D., 

Of Newark, N.J. 

No. 10. 
Cysticercus in the Eye. — The cysticercits cellulosce, 
or bladder flesh worm, is 3 to 8 lines long, has a 
small head, somev/hat similar to that of the 
tcsnia solium a short neck, which terminates in a 
serous bag 2 to 6 lines in diameter ; sexual organs 
are wanting. This parasite, at 
the present time generally look- 
ed upon as a migratory embry- 
onic tape-worm, is always, (?) 
surrounded by a newly formed 
fibrous capsule, which lies be- 
tween the muscular fasciculi. 
It is found singly or in large 
numbers in muscles or in the 
cellular tissue, and causes 
scarcely any pathological phe- 



Fig. 1. 




nomena (?). Sometimes the animal dies, and 
the sac is filled with calcareous matter. (Fors- 
ter's path. Anat., p. 539.) 

The cysticercus cellulosas occurs in various 
parts of the eye. Up to the present time it has 
been observed in the conjunctiva, the anterior 
chamber, the vitreous body, upon or in the re- 
tina, and between the retina and choroid. 
We shall consider each of these particular 
cases. 

1. Cysticercus upon the conjunctiva bulbi has 
most frequently been observed by Professor 
Sichel of Paris. It can be seen by the unarmed 
eye in the form of a tumescent, yellowish ele- 
vation, over which the conjunctiva is situated. 
In a rigid differential diagnosis it is necessary 
not to confound it with some of the many 
tumors found upon the conjunctiva ; among 
these are especially the atheromatous, fatty or 
hairy dermoidal tumors, which are generally 
situated at the corneal periphery, and which 
Sichel calls tumeurs fibreux fibro-grasseux. 
The cysticerci are not generally situated at the 
corneal margin, and by their habitus and their 
mobility render a differential diagnosis more 
easy. By excision the entozoon may easily be 
removed. 

2. If the cysticercus is situated in the anterior 
chamber it also does not become the subject of 
ophthalmoscopic examination. It is observable 
by the unarmed eye ; and, in a case observed 
and described by Grasfe, the body of the ento- 
zoon was lying in the pupil, 

while the head was impacted 
between the anterior surface of 
the iris and the membrana Des- 
cemeti corneas. The motions 
of the animal are distinctly vis- 
ible ; the iris is congested, dis- 
colored ; and this irritative con- 
dition may result in iritis. The aqueous humor 
offers a diffuse opaqueness. The parasite, in the 
case of Graefe, was removed by an incision sim- 
ilar to the extraction lineaire of Desmarres ; the 
iris regained its natural color, and after the 
lapse of a few hours, its irritative condition 
ceased ; the turbid aqueous humor escaped, 
and the chamber was soon refilled by a per- 
fectly clear fluid. 

The extracted cysticercus, placed in warm 
water, continued to move for the space of ten 
minutes. The cyst was perfectly round. If lines 
in diameter, whitish opaque, but strongly trans^ 
lucent ; the neck about 3 lines long, and be- 
tween ^ to ^ lines wide ; the head, with its suck- 




Fig. 2. 



^October 13, 1860. 



COMMUNICATIONS. 



31 




ing moutlis, measured about 3-5 of a line in 
diameter. 

3. In the vitreous body, the cysticercus has 
been observed at various points. In the cases so 
far recorded, it has always been enveloped in a 
membrane. When very young, however, the 
animal is said to want this enveloping mem- 
brane, which is formed as it progresses in its 
development. It is said, even, that older ani- 
mals are invested in seve- 
ral membranous invest- 
ments. The opthalmo- 
scope alone has the merit 
of enabling us to make a 
diagnosis of the cysticercus 
in this locality. It reveals 
the parasite as a bluish- 
green bladder, with simi- 

-t -I ,- 11 1 rm A., Fundus of the Rj'e. 

larly tmged head. Ihe b. vessels from the optic pa- 

-1 • pilla. 

enveloping membr ane c. cysticercus. 
gives it a grayish misty opaqueness. Very fre- 
quently the movements of the animal can also 
be observed; though it is asserted by Grsefe, 
that he has seen cases, undoubtedly of cysti- 
cercus, where, absolutely, no movement what- 
ever could be detected. Once, in a case where 
the cysticercus was lying behind the lens, and 
turned somewhat toward the sclerotic, Grsefe 
performed its extraction, in which he succeeded 
completely at the second attempt ; the only ac- 
cident being, that as the sac was carried through 
the incision in the scleroid, it burst and dis- 
charged its contents. The opthalmoscopic 
image, after the recovery, is thus described by 
Grrgefe : — 

"At the former seat of the extracted cysti- 
cercus, a feebly-transparent yellowish, mem- 
branous opacity was seen, which seemed to 
cover the cavity of the vitreous body like a 
precipitate. From this membrane, membra- 
nous cylinders are seen to extend through the 
vitreous humor to the wound in the sclerotic, 
indicating the course of the instrument during 
the operation." These, of course, were opaci- 
ties of the cornea. Such changes in the vitreous 
body are induced by the presence of every cys- 
ticercus ; and these opacities may lead to com- 
plete blindness. The iris sometimes becomes 
sympathetically affected when one of these pa- 
rasites is present in the vitreous body, — it dis- 
colors, becomes congested and dilated, and the 
aqueous humor may become opaque. 

4. Upon or behind the retina, the cysticercus 
has also been seen at different times, and been 
carefully observed with the ophthalmoscope. 



Here also is seen a circumscribed tumescent ele- 
vation of a greenish blue tint. The sac is more or 
less round, and the neck and head ot the para- 
site are seen attached to it. In all the cases on 
record, movements of the entozoon have been 
observed. The cyst contracts and dilates alter- 
nately ; the head retracts and projects in a simi- 
lar manner. If the cysticercus is situated upon 
the retina, the retinal vessels at that point will 
not be visible, while they are seen running over 
the animal, if it is imbedded between the cho- 
roid and retina. Opacity of the vitreous humor 
frequently results from retinal cysticercus, and 
also detachment of the retina. In such cases 
strong photopiic phenomena were frequently ex- 
perienced by the patients who saw the outlines 
of the cysticercus in a dark room, and w^hen the 
eye was shut — another proof of the old axiom, 
that retinas, functionally nearly dead, may, 
upon pressure or electric excitation, sometimes 
react in a comparatively energetic manner. As 
another result of retinal cysticercus, atrophy of 
the bulbus is mentioned. 

In order to destroy the cysticercus, it has been 
proposed, after dilating by atropia, to pour an- 
thelmintics into the eye — the former on the 
theory that atropia would loosen the lamina of 
the membranes of the eye, and hence render an 
absorption of the anthelmintics more certain. 
This method of destroying the parasite has, 
however, not been found successful. 

It has also been asserted that cysticercus oc- 
curred with especial frequency in countries in 
which the taenia was indigenous, and it has in- 
deed been found, that in the majority of cases 
observed and recorded, tmtia, or other entozoa, 
were found in the same patients. In a number 
of cases, however, of cysticercus of the eye, no 
other entozoa could be found. 

This concludes what is known of the cysticer- 
cus in its ophthalmoscopic relations at the pre- 
sent time. It would afford me pleasure if the 
hints here given would, with an accurate and 
conscientious examination, lead the reader to de- 
tect and publish a description of this curious 
and interesting parasite. 



Of all the methods of keeping a patient warm, 
the very worst is certainly to depend for heat 
on the breast and bodies of the sick, I have 
known a medical officer keep his ward v/indows 
hermetically closed — thus exposing the sick 
to all the dangers of an infected atniosphere, 
because he was afraid that, by admitting fresh 
air, the temperature of the ward would be too 
much lowered. This is a destructive fallacy.— 
Florence Nightingale. 



32 



COMMUNICATIONS. 



Vol. V. No. 2 1 



Mortuary Record of Sussex County, Dela- 
ware, with Remarks on the Prevalence of 
Typhoid and Remittent Fever. 

By D. W. Maull, M. D., 
Of Georgetown, Del. 

Statistical information recently elicited, 
which, if it does not develop fully and with 
precision, the hygienic status of the county, in 
determining the degree of the prevalence of 
diseases and their general character, at least 
exhibits partial results of that condition by the 
aggregate of mortality attendant upon the ope- 
rations of the morbific states, which affected 
the community within a given period of time. 
Such knowledge, amassed from the vital statis- 
tics, cannot be otherwise than valuable and im- 
portant, since it becomes an exponent of the 
relative mortality of various sections of coun- 
try and of the comparative ratio of longevity. 

Sussex county has a population of 29,509 
souls ; of this number 1,195 are slaves. The 
death recorded within one year, dating from the 
1st of June, 1859, to the 1st of June, 1860, were 
340 ; of those that died, 163 were males and 177 
females. By this it will appear that the per 
centum of deaths to the population was 1.38. 

The causes which induced this loss of life may 
thus be summed up : — Consumption, 49 ; pneu- 
monia, 16 ; whooping cough, 2 ; croup, 20 ; dis- 
ease of the throat, 5 ; pleurisy, 3 ; catarrh, 4 ; 
bronchitis, 1 ; disease of the liver, 5 ; dysentery, 
16 ; gastritis, 2 ; dyspepsia, 3 ; diarrhoea, 4; Cho- 
lera morbus, 1 ; cholera infantum, 1 ; colic, 3 ; 
jaundice, 1 ; thrush, 1 ; marasmus, 1 ; typhoid 
fever, 24 ; remittent fever, 6 ; yellow fever, 1 ; 
chicken pox, 1 ; small pox, 1 ; scarlet fever, 8 ; 
erysipelas, 2 ; measles, 1 ; scrofula, 1 ; cancer, 
7 ; dropsy, 13 ; gravel, 3 ; cystitis, 1 ; dentition, 
3 ; paralysis, 10 ; inflammation of the brain, 6 ; 
spinal disease, 1 ; convulsions, 9 ; tetanus, 1 ; 
mania a potu, 1 ; disease of the heart, 2 ; rheu- 
matism, 3 ; worms, 1 ; old age, 8 ; hernia, 1 ; ab- 
scess, 2 ; mortification, 1 ; suicide, 1 ; burns, 5 ; 
childbirth, 11 ; drowned, 3 ; injuries, 4 ; frights 
1 ; violence 2 ; accidental poisoning, 1 ; un- 
known, 43. 

One must needs be impressed with the ratio 
of consumption, and of diseases of the respira- 
tory system generally, to the entire list of other 
affections, for it will be observed that the pro- 
portion of deaths froin phthisis, as to the others 
aggregated, is 14 per cent., whilst the deaths 
from the disorders of the respiratory apparatus 



is at least 33 per cent, of all, or as 1 to 3. This 
degree of mortality incident to affections of the 
air passages, is due to the climate, which at 
times is variable in the extreme, and especially 
in those months during which we naturally an- 
ticipate functional derangements of those or- 
gans, for we find that a large proportion of 
them occurred during the winter and spring 
months, when the variations are greatest and 
most frequent. 

One fact, which must become apparent to the 
mind of any one who has instituted an examina- 
tion of the returns for this county, is the fre- 
quency of deaths from consumption among the 
blacks, as compared with the deaths from this 
cause among the whites. This difference is 
chargeable in part to the circumstance of more 
frequent exposure upon the part of the negro, 
and the want of means, dietetic and medicinal, 
to resist the encroachments of the malady in its 
incipiency. From the general surroundings of 
this class of population, the course of the dis- 
ease is commonly not so protracted as its dura- 
tion in the white ; they succumb much sooner 
to its ravages. 

Again, in this connection, it has been pre- 
sumed, from the evidences frequently present- 
ing themselves to the attention of the observer, 
that consumption was slightly on the increase 
in this county. This is no longer a presump- 
tion, but a fact ; for the census of 1850, together 
with the recent one, attests it. Thus we find, 
from those portions of the census of 1850 for 
this county accessible, that, in 152 deaths re- 
corded, only 15 deaths from consumption are 
noted, making only ten per centum, denoting 
within the past decade an increase of four per 
centum in this disease ; to what this increase is 
due, we are unable to determine — whether to 
climatic modifications or to non-natural influ- 
ences, we will not hazard an opinion ; the fact 
remains the same, though the agencies are un- 
known. 

Another development which is impressive, and 
at the same time somewhat startling, is the 
number of deaths from typhoid fever recorded ; 
and when we take into consideration the fact, 
that, in addition to the fatal cases chronicled, 
there must have been, according to the laws of 
pathology, many cases the termination of which 
was favorable, an idea may be had of the preva- 
lence of this disease in the county. We ob- 
serve, from the preceding synopsis of causes, 24 
deaths from typhoid fever noted — thus consti- 
tuting a per centum of 7 to the entire number 



October 13, 1860. 



COMMUNICATIONS. 



33 



of fatal cases from all sources. In the partial 
returns for 1850, above alluded to, we find not a 
death in 152 from this disease, though two 
deaths from typhus fever are noted. 

En passant, typhoid fever, it may be declared, 
is evidently increasing in frequency in Sussex — 
appearing to manifest a disposition to supplant 
our remittent fevers and to obtain a foothold 
among us. It has been but within late years 
that it has obtruded itself upon the attention of 
the practitioner ; now it is making slow, but 
sure, advances, and the probability is, that the 
time is not far distant when this disease, an ex- 
otic, shall become domesticated with us and be 
one of our ordinary diseases. As our bilious 
fevers diminish, and thus leave a vacuity, as it 
were, the typhoid endeavors to occupy its place. 
As to the habits of this latter fever, it is more 
rife in the north-eastern and eastern portions, 
along the coast and all the large streams, than 
in the interior. It appears, in a great measure, 
with us to be dependent upon some cause con- 
nected with bodies of water ; as in the vicinity 
of these, it is most frequent. 

That our " bilious" is being modified in its 
nature, appears from the last two census re- 
ports ; as an illustration, we find for the year 
1850, 16 per cent, of deaths from bilious fever, 
whilst from the present census, among 340 
deaths, we find but 6 deaths from this endemic, 
or 1.38 per cent. Ten years ago, the physicians 
of this county knew practically little compara- 
tively of typhoid fever ; remittent fever they 
were called upon more generally to combat ; 
now the bilious has become more tractable, and 
results but seldom in death ; especially a pure, 
uncomplicated case. That the bilious should 
be less frequent and less dangerous, is not sur- 
prising at all ; a satisfactory solution can be 
given in the fact, that the face of the country 
has been sensibly modified by the extensive sys- 
tems of drainage pursued of late years, and by 
the immense area of swamp land cleared up and 
placed in cultivation ; added to this, large 
amounts of lime applied to these low grounds — 
thus in part neutralizing the malarial poisons — 
and we have a solution. 

The ratio of deaths from diseases of the di- 
gestive apparatus, as to deaths from other 
causes, was 1 to 12 ; showing a considerable 
mortality from dysentery. One case of yellow 
fever is recorded: this was not indigenous to 
the locality, but the victim was a sailor from a 
Southern port, where he received the seeds of 
disease. A fatal case of chicken pox is also 



noted : this would appear surprising, had it not 
occurred in the person of a young boy with a 
cachectic habit of body, with a strong scrofu- 
lous vice. 

The deaths resulting from external, or causes 
not depending upon climate or season, amount 
to 18, as observable from the table of mortality. 

The mortality as to ages, was as follows* 
139 were under 5 years of age ; 14 were between 
the ages of 5 and 10 ; 27 were between the ages 
of 10 and 20 ; 38 were between the ages of 20 
and 30 ; 24 were between the ages of 30 and 40; 
29 were between the ages of 40 and 50 ; 21 were 
between the ages of 50 and 60 ; 24 were between 
the ages of 60 and 70 ; 15 were between the ages 
of 70 and 80 ; 6 were between the ages of 80 
and 90 ; 3 were between the ages of 90 and 100, 
Of the advanced ages, 1 was 82 ; 2 were 84 ; 1 was 
87 ; 1 was 88 ; 1 was 89 ; 1 was 91 ; 1 was 92 ; 
and 1 was 100 ; the latter was a negro woman. 
The greatest mortality, it will be observed, was 
among children under 5 years of age, the per 
centage having been about 40. 

In G-eorgetown, three died during the year, 
whose united ages were 251, the eldest being 92. 
The town, having a population of 608, had 9 
deaths during the year, being a ratio of 1.44 
to every hundred of population. 

The number of deaths among the free negroes, 
as compared with the fatality among the slave 
population, is unfavorable to the former, for of 
80 negroes that died, 53 were free ; this difi'er- 
ence may be accounted for by the fact that those 
negroes as a class were thriftless, and lived in 
squalid poverty, without the means necessary 
to obtain the comforts essential to the sick, and 
medical assistance in every case ; the essential^ 
to recovery were in a great measure wanting to 
them. 

Desiring to show in what months the health- 
modifying influences were operating with most 
efifect, the following has been tabulated : Deaths 
— 23 in January ; 23 in February ; 36 in March ; 
37 in April ; 25 in May ; 32 in June ; 37 in July ; 
33 in August ; 23 in September ; 27 in October ; 
28 in November ; and 16 in December. 

Deaths from consumption occurred : 3 in- 
stances in January ; 6 in February; 10 in March; 
5 in April; 3 in June; 4 in July; 3 in August; 
4 in September ; 4 in October ; 4 in December. 
One-fifth of all the deaths from this cause occur- 
red in March, and there was not a death from 
this disease, either in May or November. 

There resulted from typhoid fever 1 death in 
January; 1 in March; 1 in April; 2 in May; 



34 



COMMUNICATIONS. 



Vol. V. No. 2. 



2 in July; 5 in August; 5 in September; 1 in 
October; 3 in November; 3 in December. Of 
13 cases, the record of which we have examined, 
we find that 2 were under 11 years of age ; 1 was 
13 ; 1 was 14 ; 1 was 16 ; 1 was 17 ; 2 were 18 ; 
2 were 20 ; 1 was 28 ; 1 was 42 ; 1 was 67 ; the 
latter being most likely a case of bilious mer- 
ging into typhoid, as is its wont in old and re- 
laxed subjects, in many instances. Of these 
cases, 8 were females, and 5 were males. 

There resulted from dysentery 1 death in Janu- 
ary ; 1 in March ; 1 in May ; 3 in June ; 5 in July 
and 1 in August; showing the greatest amount of 
mortality from this source in July, a time when 
our bilious fevers have not made their appear- 
ance generally, and when we naturally look for 
the former disease to show itself in greatest 
force. 

If it were possible, it would be interesting to 
note the ratio of deaths to the number of cases 
of illness during the period referred to, in order 
that we might more accurately estimate the 
character of our diseases by their termination ; 
but there are no data, save that offered by gene- 
ral observation, which is so meagre, that an 
approximation cannot even be formed ; the com- 
bined notes of all the physicians of the county 
would afford the only means of judging. 

Whether there was about the average amount 
of sickness during the twelve months, through- 
out the county, cannot be positively determined. 
From our notes, we find that very early in the 
season of 1859, the bilious commenced ; having 
presented itself in May, which was something 
remarkable ; it appeared to be genuine remittent 
fever. There was also some intermittent fever. 
The rains had been very frequent since the first 
of the year more than 20 inches having fallen 
in that time ; the wind, for much of the time, 
had been from the east, and the weather was 
damp and variable ; the swamps and low 
grounds had been for the most part covered with 
water, and the weather at times quite warm, 
the thermometer indicating 86° in the shade. 
There being a sensible connection between at- 
mospheric conditions and the prevalence of dis- 
ease, it may not be superfluous to state, that the 
year 1859 was essentially a pluvial one, 54.42 
inches of rain having fallen, there having been 
96 days in which we had rain. It is easy to 
imagine from this hygrometric state, that pul- 
monic complaints should be rife in the commu- 
nity. 

From the first of the present year up to June, 
13.02 inches of rain fell ; the variations of the 



Gilman's Treatment of In-g^rowing K'ail. 

By Henry M. Clarkson, M. D., 

Of Wateree, Kichland Dist., So. Ca. 

Mrs. S., a young married lady, applied to me 
on the 12th of March last, to be treated for an 
in-growing of the nail of the great toe. 

She had not been able to wear the softest 
shoe for many months, or bear the lightest 
touch of the finger upon the parts adjacent to 
the sore. This w^as on the inner side of the 
nail, near the root, discharging pus, and sur- 
rounded by great inflammation. 

Unwilling to subject one of so delicate a con- 
stitution and so nervous a temperament to the 
painful application of nitrate of silver, or to the 
severe operation of extracting the nail, I re- 
sorted to the plan recommended by Dr. N. 
Oilman, of Hatfield, Mass., (Boston Med. and 
Surg. Journ., Dec. 29, 1859.) 

Having held a small piece of tallow in a 
spoon over the flame of a lamp, until it melted 



weather were frequent and severe in the early 
season ; the respiratory system was peculiarly 
obnoxious to attacks. Pneumonia was espe- 
cially prevalent throughout a large section of 
the county ; in some neighborhoods it was quite 
fatal. 

Now, the inquiry may be made, what is the 
relative longevity in Sussex county ? The data, 
as furnished by the present census, will enable 
us to determine it for one year, according to the 
principle which is usually regarded as a mode 
for estimating it. 

The principle is, "the ratio of deaths to the 
population in any community is deemed com- 
monly an index of the average duration of life 
in that community ; as an illustration, if 1 in 45 \ 
dies yearly, the average of all who die, will be 
45. From a table before us, it appears that in 
London, the proportion of deaths to the popu- 
lation, at the commencement of the last cen- 
tury, was 1 in 20 ; at another time it was 1 in 
39 ; and at another 1 in 40 ; and at other times 
intermediate ages between the minimum and 
the maximum mentioned. Taking this princi- 
ple for our guide, we find that the average du- 
ration of life is 86 years, as the ratio of deaths 
to the population of Sussex is 1 in 86 ; this es- 
timate will appear too high, however. Be that 
as it may, enough has been developed to show 
that the average duration of life is much higher 
than in the cities, and that it will com23are 
favorably with most rural districts. 



October 13, 1860. 



COMMUNICATIONS. 



35 



and became very hot, I dropped two or three 
drops of it upon the seat of the granulations, 
and directed the patient not to attempt to put 
on her shoe until a cure was accomplished. 
After this visit I did not see her for several 
days, when I was gratified to find the granu- 
lations gone, and the pain and tenderness effec- 
tually relieved. Paring away the exposed edge 
of the nail, in ten days later she was walking 
about, wearing her shoe with comfort ; and at 
the present time, (six months since), there ap- 
pears not to be the slightest probability of a 
return of the complaint. 

When it is recollected, how frequently sur- 
geons pronounce the operation of extracting the 
nail one of the most excruciating in practice, 
necessitating the use of anassthetics, and that 
cauterization by nitrate of silver is always 
dreaded, it is to be hoped that others will sub- 
stitute for such barbarous treatment this simple 
method of Dr. Oilman, as one suitable for self- 
application, quick in giving relief, effectual in 
curing, without pain, and last, though not 
least, obviating the risk in resorting to chloro- 
form. 



An Extraordinary Case of Ascites. 

By Samuel M. King, M. D., 

Of Monongahela City, Pa. 

Last November I reported (vol. iii, p. 178) a 
case of ascites, that of Mrs. Adams, which is 
remarkable for the large amount of serum 
effused, and the number of times the operation 
of paracentesis abdominis was performed. A 
continuation of the report may be of interest to 
the reader. 

From February 1st, 1854, to October 18th, 
1859, she had been tapped over fifty times, and 
the amount of fluid discharged was 628 gallons, 
2 quarts, IJ pints. From that time the record 
runs as follows : 





Gallons. 


Quarts. 


Pints. 


Previously reported. 


628 


2 


IJ 


Nov. 22d, 1859, drew off. 


12 


9 


1 


Dec. 20th, " 


13 








Jan'y 17th, 1860, " 


13 


1 


J 


Feb.' 15th, " 


13 


1 




March 17th, " 


12 


2 


1 


April 15th, " 


13 




^ 


May 16th, " 


13 


2 


I 


June 14th, " 


13 


2 




July 11th, " 


12 


3 


1 


Aug. 7th, " " 


14 


1 




Sept. 8th, " 


13 




1 


Amounting in all, up to 








this time, to - - 


774 





i 



Mrs. Adams continues to enjoy tolerably good 
health for one in her situation. In some re- 
spects she has improved since the last report ; 
a cough, that annoyed her very much for years, 
has ceased entirely for som.e months. 

Oct. IsL 1860. 



llWratinns of lospital frattia 

PENNSYLVANIA HOSPITAL. 

Service ot Dr. J. Forsyth Meigs, 
ANEURISM OF THE AORTA. 

A man, about 50 years of age, came into the 
house suffering from asthma, dyspnoea, and a 
somewhat stridulous laryngeal or tracheal re- 
spiration. There was no aphonia, nor could 
any inflammation of the throat be detected. 

The patient dates his disease since Christ- 
mas, when he had some pain in the right side, 
and at the same time found that, contrary to 
previous habit, he could carry heavier weights 
on his left shoulder than on the right. The 
stridulous respiration, in the absence of any in- 
flammation in the trachea or larynx, together 
with the absence of any other positive symp- 
toms ; his appetite being good, no emaciation 
having taken place, and there being no tubercu- 
lar tendency, reduce the diagnosis to the exist- 
ence of an intra-thoracic tumor of some kind 
pressing upon the trachea, which maybe either 
an aneurism, a cancerous growth, a mediastinal 
tumor, or an abscess. But the three latter must 
be thrown out in this case ; he has not the 
cachectic appearance, the pain, and other gene- 
ral symptoms accompanying cancer ; nor has 
he had the secondary, hectic fever, with rigors 
and chills, accompanying the formation of an 
internal abscess ; and, as far as a mediastinal 
tumor is concerned, we have other symptoms, 
which, by establishing the case as one of aneu- 
rism, exclude the former. 

On inspection, there is a slight prominence or 
bulging, some protrusion of the thoracic walls, 
over the right infra-clavicular region. The 
veins of the neck on the right side, especially 
the jugulars, and the veins of the arm on that 
side, are fuller than those on the opposite side, 
especially when he lies down. The thoracic 
veins of that side are also somewhat enlarged. 

Percussion demonstrates a want of tone, and 
some dullness over the bulging part of the in- 
fra-clavicular region. On placing a stethoscope 
over this region, a slight pulsatory impulse is 
given to it. The apex-beat of the heart is more 
to the left than it should be. 

NEURALGIA. SUBCUTANEOUS INJECTIONS. 

The subject of this disease is a young woman, 
who came into the hospital August 14th, suf- 



36 



HOSPITAL PEACTICE. 



Vol. V. No. 2. 



fering most intensely from pain in the loins and 
along the sciatic nerve. The heart is perfectly 
sound, she had never suffered from rheumatism, 
there is no pulmonary disease, she has not had 
typhoid fever — in short there is no organic lesion 
to be found anywhere, and the diagnosis must 
hence be reduced to that of simple neuralgia. 

Her suffering was so intense, the pain so 
agonizing, that immediately on her admission 
a subcutaneous injection of a solution of mor- 
phia, — 20 minims of 16 grains to f. ^j. of water 
was applied, which gave temporary relief, and 
at the same time tinct. opii and Valerianae in 
proper doses were administered. The pain, 
however, returned, and we have been obliged 
to resort to injections again and again — eleven 
in all. 

On the 14th of August the opium and valerian 
were omitted, and 15 drops of the muriated 
tincture of iron given three times a day. This 
being followed by no very marked improvement, 
on the 24th of August 5 grains of iodide of 
potassium with wine of colchicum, 3 times a 
day, was substituted. But this in its turn was 
also suspended early in September, and she was 
placed under Todd's anti-neuralgic mixture, 
which consists of 15 grains of bicarbonate of 
potassa, 10 drops of tincture of opium, and 5 
grains of nitrate of potassa. Under this, with 
the occasional application of hypodermic in- 
jections, she has been gradually improving, but 
still is not entirely free from the affection. 

The case is one of considerable interest, as it 
presents a type of a class occurring very frequent- 
ly, and often causing the physician much vexa- 
tion. Sick headache, or migraine, and other 
forms of neuralgia are most frequently caused by 
nervous exhaustion, care, want of sleep, brought 
on by over exertion of the brain, with a state 
of the blood insufficient to supply the organ 
with its proper stimulus. It may be looked 
upon as an hyperesthesia of the cerebrum 
itself. 

We find this disease most commonly in hard- 
working, broken down merchants, lawyers and 
clergymen, whose habits are sedentary, whose 
appetite is poor, digestion bad, and who, with 
all this, exercise their brain day and night. It 
occurs in women, who have a large family of 
children, household cares, are perhaps nursing, 
and robbed of their sleep, and from these causes 
become anaemic. Romberg, than whom there 
is no better authority in diseases of the nervous 
system, calls neuralgia " the 'prayer of the nerves 
for healthy hlood,'^ and experience has proved 
that he is right. The treatment in these cases 
must always be tonic, and the diet should be 
simple but nutritious. Iron should form the 
basis of the treatment, and quinine is a most 
important auxiliary. 

H.EMOPTTSIS. 

This patient, a man 34 years of age, was 
an inmate of the hospital in March last, suffer- 



ing from scurvy ; the hemorrhagic blotches 
being limited chiefly to the legs. There was no 
active haemorrhage then. He w^ent out, appa- 
rently in perfect health, in May. 

On the 2d of July he returned to the hospital, 
having then been spitting blood for about a 
week. The haemoptysis was very copious, and 
continued for two weeks, in spite of all that 
could be done. He was in so exhausted and 
weak, a condition that, of course a thorough phy- 
sical examination could not be made. 

Ten drops of oil of turpentine were given 
every two hours, he was dry-cupped, and three 
grains of gallic acid were given every three or 
four hours. Light, but somewhat nutritious 
diet, such as milk and bread, was ordered. 

August 5th. A blister was applied over the 
sternum. 

Aug. 10th. Two grains of gallic acid ordered, 
together with J grain of opium every two hours, 
when awake. 

Aug. 21st. The haemoptysis having almost 
entirely ceased, it was thought time to com- 
mence building him up ; 10 drops of tinct. nuc. 
vom. with one drachm of compound tincture of 
gentian twice or three times a day were ordered 
and the to diet consist of mutton chops, milk, 
eggs, porter, etc. 

Physical Examination. — There is now no cough- 
ing ; expectoration very slight. 

Percussion yields a slight dulness over the 
left supra-spinal fossa ; there is also some dul- 
ness below the clavicle on both sides, and a little 
sinking in. 

On auscultation there is found to be prolonged 
expiratory murmur over the left clavicle ; at the 
same time the expiratory murmur is somewhat 
rough or harsh. There can scarcely be a doubt 
that this patient has tubercles, probably miliary 
in both of his lungs. 

The prognosis of tubercular disease, at pre- 
sent, is not considered so unfavorable as it was 
twenty or thirty years ago, when pulmonary 
tuberculosis and death were almost synonyms. 
Though the disease can, properly speaking, not 
be cured, that is to say, the tuberculized por- 
tion of the lung, cannot be brought back to be 
sound lung-tissue, the development of tubercles, 
and their progress may be arrested under favora- 
ble circumstances, the disease be held in abey- 
ance. In connection with this subject, we may 
quote Dr. Walshe, a recent authority of high 
repute, who says : 

The following results, which I obtained at 
the Consumption Hospital, justify the fore- 
going statements, and furnish guides to prog- 
nosis additional to those already set forth. (1.) 
Of a given mass of patients entering the hospi- 
tal in all stages of the disease, and in every 
variety of general condition — between the ac- 
tually moribund state, and that of but slight 
constitutional suffering — the number leaving it 
on the one hand, improved or unadvanced was 
more than double that on the other hand, leav- 



October 13, 1860. 



HOSPITAL PEACTICE. 



37 



ing it in a worse state, or dying luithin its walls, 
(the exact ratio is 67.84; 32.16.) If the cases 
in which death was actually imminent at the 
period of admission were excluded, the result 
would be very materially more favorable than 
this. (2.) In 4.26 per cent, of the cases, com- 
plete restoration to health, not only as re- 
gards apparent disturbance of the functions 
generally, but as regards local evidence of 
active pulmonary disease was effected. (3.) 
Complete removal of symptoms was more fre- 
quently effected in the male than in the female ; 
but, on the other hand, the results were, on the 
whole, slightly more favorable in the latter 
than in the former sex. (4.) All patients whose 
conditions grew worse, while they were in the 
hospital, had reached the stage of excavation 
on admission ; and all patients, whose tuber- 
cles were yet unsoftened on admission, left the 
hospital either improved, or having had a 
status in quo condition kept up. Improvement 
is more probable than the reverse, even where 
excavation exists on admission. (5.) In a 
given mass of cases, the chances of favorable 
influence from sojourn in the hospital will be 
greater, in a certain, undetermined, ratio, as 
the duration of the disease previous to admis- 
sion has been greater — in other terms, natural 
tendency to a slow course is a more important 
element of success in the treatment of the dis- 
ease, than the fact of that treatment having 
been undertaken" at an early period. (6.) The 
mean length of stay in the hospital in the most 
favorable class of cases, nearly doubled that in 
the least favorable. (7.) The chances of benefit 
are more in favor of those whose trades are 
wholly or partially pursued out of doors. (8.) 
The results did not appear to be influenced by 
the laborious or non-laborious character of the 
trade individuals might have pursued. (9.) 
The age of the sufferers did not exercise any 
very material influence on the character of the 
results. (10.) Patients coming from the coun- 
try have, on an average, a slightly stronger 
chance of improvement, than the residents of 
London and the suburlDs. (11.) Patients ad- 
mitted during the warmer half of the year, 
benefit by a sojourn at Brompton, to a slight 
extent more than those received during the six 
colder months. 



HOWARD HOSPITAL. 

SerTice of Dr. S. W. Gross. 
[Eeported by J. Eufus Tryon, Eesident Physician.] 

STOXE IN THE BLADDER LATERAL OPERATION 

UXIOX OF THE WOUND BY THE FIRST INTENTION. 

William Holland, two years and a half of 
age, born in Leeds, England, was admitted into 
the Howard Hospital on the 18th of Septem- 
ber, 1860. He had suffered from symptoms of 
vesical calculus for the last nine months, pass- 
ing his urine from twenty to thirty times in the 



twenty-four hours. Micturition was always at- 
tended with pain, especially at the completion 
of the act ; and there was occasionally a sud- 
den interruption in the flow of urine, causing 
the boy to flex his body far forward, in order 
to disengage the stone from the mouth of the 
urethra. He had pain and itching at the head 
of the penis, to relieve which he was constantly 
pulling at the head of the organ, thus causing 
elongation of the prepuce. He has never had 
prolapse of the rectum ; nor was there ever any 
calculous disease in his family. Three weeks 
previous to his admission, as well as the day 
before the operation, the patient was sounded, 
and a stone was detected. He was placed upon 
the use of bicarbonate of soda, under which the 
symptoms of vesical irritation abated. 

On the morning of the 18th of September, 
the patient having been put under the influence 
of chloroform, the ordinary lateral operation 
was performed with a scalpel, the lower bowel 
having the night previous been cleared out with 
castor-oil. The external incision was about an 
inch and a quarter in length, and the internal in- 
cision was limited to simply notching the mem- 
branous portion of the urethra, the prostrate 
being lacerated with the index finger to an extent 
just sufficient to admit of the introduction of a 
small pair of forceps. The calculus was extracted 
without any difficulty, and was six lines in 
length by two in breadth, and weighed nine 
grains. It was quite friable, and was phos- 
phatic in its composition. Six drops of lauda- 
num were administered after the operation. The 
perineum was much deeper than is usual with 
subjects so young. 

September 19th, 10 A. M. From the time of 
the operation, the boy has slept soundly, 
awakening twice, when he took some bread and 
milk, and has suffered no pain. The urine 
passed through the wound several times during 
the afternoon and night ; but at seven o'clock this 
morning, or nineteen hours after the operation, it 
came away by the penis, and so continued until a cure 
was effected, not a drop issuing from the wound. The 
small size of the internal and external incisions, 
no doubt, contributed, in great measure, to this 
very unusual result, 

September 20th. This morning the boy had 
an action on his bowels. He sleeps well, has a 
good appetite, and is free from pain. While the 
nurse was out of the room, he got up and 
walked about; but strict watching was en- 
forced, so that it should not occur again. 

The progress of the case was unattended by 
any bad symptom, and the child's mother 
stated that he enjoyed more freedom from suf- 
fering than he had for the last six months. It 
was almost impossible to keep him confined to 
his bed, and on the sixth day after the opera- 
tion he was discharged from the hospital ; after 
which he was visited at his residence. On the 



38 



HOSPITAL PEACTICE. 



Vol. V. No. 2. 



eighth, day, the external wound had entirely 
closed ; but the boy was visited every day or 
two until the 8th of October, at which time he 
was playing about and perfectly happy. As 
the bowels acted regularly every day, the after- 
treatment was confined to the administration of 
bicarbonate of soda. 

HEREDITARY SYPHILITIC CONDYLOMATA AT THE 
VERGE OF THE ANUS. 

Mary McKenna, twelve years of age, was ad- 
mitted to the Hospital, on the 2d of August, 
1860, on account of condylomatous growths of 
the anus, the result of heriditary syphilis. The 
child did not present any other sign of constitu- 
tional disease, but was emaciated and pale, and 
her general health was bad. The mother had 
suffered from ulceration of the throat, alopecia, 
nodes on the tibige, and a papular eruption, 
and had had four children, one of which was 
born infected and died soon afterwards. The 
growth commenced about two months ago as a 
small red spot, which soon spread, and has 
now become of the size of a twenty-five cent 
piece. Its surface is slightly tuberculated ; it 
has a fibrous feel, is of a red color, and of an 
irregular shape, and about two lines in height. 
Itching has been a troblesome symptom, be- 
coming worse by exercise, and when she gets 
warm in her bed, requiring her to scratch and 
rub the part, which gives rise to pain, and oc- 
casionally to bleeding. 

The treatment consisted in the internal admin- 
istration of a solution containing five grains of 
iodide of potassium, with the twentieth of a 
grain of bichloride of mercury, every eight 
hours. She was also placed upon the use of 
the tincture of the chloride of iron, and was 
allowed a generous diet. As a topical remedy, 
chromic acid in the proportion of one hundred 
grains to the ounce of water was applied, and 
strict cleanliness was enjoined. Under this 
course of treatment, the tubercles had disap- 
peared at the end of three weeks, the chromic 
acid having been applied but three times, and 
at intervals of six days. To prevent a recur- 
rence of the disease, cleanliness was ordered to 
be kept up, and the cons'itutional remedies 
were continued for several weeks, the effects 
of the bichloride of mercury being carefully 
watched. 

CASE or SYPHILITIC HYDROSARCOCELE. 

J. B., an Irish laborer, forty-five years of age, 
presented himself at the clinic of Dr. Gross, on 
the 2d of July, 1880, on account of a scrotal 
tumor, which had existed nearly three years. 
Twenty-two years ago, he had had an indurated 
chancre, followed by a bubo, and has occasion- 
ally been the subject of the different symptoms of 
constitutional syphilis. At the present time he 



suffers from nocturnal rheumatism, and he is pale 
and cachectic, and his appetite is impaired. Upon 
examination of the scrotum, the left sac of the 
vaginal tunic was found to be distended with 
serum to about the size of a goose's egg, and 
upon evacuating the water, the testicle was felt 
to be greatly enlarged, being four times its 
natural bulk, very knobby and indurated, as 
well as very heavy. The epididymis was also 
involved in the disease, and the spermatic cord, ■ 
as far up as the external ring was very much 
enlarged, and occasionally the seat of sharp, 
shooting pains. The hypogastric and right and ' 
left iliac regions were the seat of pustular erup- 
tions of an ecthymatous character, and of about j 
fifteen deep sores, with foul bottoms, and vary- 
ing in size from a three cent piece up to that of 
a twenty-five cent piece. 

Treatment. — The left side of the scrotum was 
ordered to be painted twice a day with the tincture : 
ofiodine, andtobekeptwellsuspended. Thesoresi 
were touched with a dilute solution of acid nitrate 
of mercury, and poultices were to be applied, 
until they assumed a healthy granulating ap- 
pearance. He was placed upon a nutritious diet, 
with malt liquor, and took every eight hours 
ten grains of iodide of potassium, with the! 
eighth of a grain of bichloride of mercury. 

On the 9th of July, the scrotum was punc- 
tured to give egress to serum which had again 
accumulated, and at this time the testicle and 
spermatic cord were not so hard, and the sores, 
having assumed a healthy aspect, were ordered 
to be dressed with one part of citrine ointment 
to seven of simple cerate. The application of 
iodine to the scrotum was discontinued, and 
mercurial ointm.ent substituted. One week sub- 
sequently the patient had become slightly sali- 
vated, and the iodide of potassium was admin- 
istered alone, the blue ointment and bichoride 
of mercury being stopped, and the iodine beingi 
again applied. The sores were in great part 
healed, and very considerable diminution had 
taken place in the size of the cord and testis. 
From this period the case progressed favorably, 
and on the thirteenth of August he was dis- 
missed. His general health had greatly im- 
pro^^ed, his sleep was undisturbed by rheuma- 
tism, the ulcers had perfectly healed, and thei 
testis and spermatic cord were reduced to almost! 
their natural dimensions, although the former 
organ still felt somewhat tuberculated. He| 
was ordered to continue the iodide of potassium 
for three weeks longer, and to pay special at- 
tention to his secretions. 



It seems a commonly received idea among 
men, and even among women themselves, that 
it requires nothing but a disappointment in love,i 
the want of an object, a general disgust or inca- 
pacity for other things, to turn a woman into aj 
good nurse. This reminds one of the parish, 
where a stupid old man was set to be school- 
master because he was " past keeping the pigs." 
Florence Nightingale. 



October 13, 1860. 



HOSPITAL PEACTICE. 



39 



UNIVERSITY OF PENNSYLVANIA. 

MEDICAL DEPARTMENT. 
(Service of Dr. Pepper.) 

September 25th. 

INCIPIENT softening OF THE BRAIN. 

The patient is a man, 42 years of age, a sea- 
captain, who has always enjoyed good health. 
He left sea last December. He has been a 
moderate drinker. About twelve weeks ago^ 
he began to feel weak, and was obliged to 
stop his business. 

He has now some difficulty in walking. His 
gait is somewhat rolling, staggering like that 
of a man on board of a ship. His grasp is 
feeble. There is a general loss of muscular 
power ; he has, hoM^ever, full power of co-ordi- 
nating his muscular motions. The lower ex- 
tremities appear in a weaker condition than 
the upper. There is some loss of hearing, but 
the sight is equally good in both eyes. 

On auscultation, the sounds of the heart are 
found to be perfectly normal. The condition 
of his mind is good, with the exception of a 
slight hesitancy in his speech. 

The patient is evidently threatened with 
general paralysis, in consequence of softening 
of the brain. It is not a case of apoplexy, 
though that may finally take place. 

Disease of the heart is not unfrequently fol- 
lowed by softening of the brain, in consequence 
of fatty or atheromatous degeneration of the 
cerebral vessels, the same as takes place in the 
heart or aorta, and for this reason the heart of 
this patient has been examined, with a view to 
see whether any such connection exists in this 
case. The heart, however, is sound. 

Softening of the brain is generally looked 
upon as an incurable disease. It is stated, 
however, by some authorities, that as long as 
the brain-fibres have not given way and become 
disorganized, the disease may be curable, or at 
least held in abeyance by proper treatment. 

Treatment. — This is to consist in a sustaining 
diet and a tonic course. The patient is to be 
built up. His food should be simple and nu- 
tritious, and he should abstain from alcohol or 
tobacco. As a tonic, he is to take one grain of 
quinia with two grains of extract of gentian 
three times a day. Counter-irritants are to be 
applied to his back, and his bowels to be kept 
in a soluble condition. 

Oct. 2d. The patient presented himself again 
at the clinic, somewhat improved. The same 
treatment to be continued. 

PHTHISIS IN A CHILD TWO AND A HALF YEARS OF 
AGE. 

The child was brought to the clinic by its 
mother, who is a very healthy looking woman, 
and who states that her husband, as well as the 



rest of her children are all healthy, and that 
there is no consumption in her family. 

The child has been sick a year, but during 
the last four months has become markedly 
worse, emaciating considerably ; it has a hot, 
dry skin, indicating hectic fever, and a very 
fetid smell of the breath. 

On physical examination, there is well-marked 
cavernous respiration in the upper lobe of the 
left lung, with pectoriloquy and dulness on 
percussion. The right lung appears sound. 
There is evidently a cavity in the upper part of 
the left lung. 

This is rather a rare case. Tubercular de- 
generation in children at this age is generally 
disseminated all over the lung in the form of 
miliary turbercles, and it is not very often 
that we find it occupying the position, and run- 
ning the course it does in the adult. 

The bad odor, approaching to that almost of 
gangrene, is caused by the decomposing puru- 
lent matter in the cavity, which is acted upon 
by the inspired air, and which, in children so 
young, cannot be expectorated. 

Cases of this kind might be mistaken for gan- 
grene, pneumonia, or pleurisy ; but the history 
of the case on one hand, and the physical signs 
on the other, are sufficiently clear to make a 
diagnosis certain. A case of gangrene would 
be much more rapid in its course than this case 
has been. It being limited to the upper lobe 
of one lung, with cavernous respiration and 
pectoriloquy, preclude the theory of pneumo- 
nia, pleurisy, or empyema. 

Treatment. — There being no hereditary tuber- 
cular taint, the digestion being yet tolerably 
good, the progress of the disease may be consi- 
derably retarded, though we can hardly hope 
for a cure. Cod liver oil, wine whey, beef tea, 
and ^ of a grain of sulphate of quinia, three 
times a day, constitutes the best treatment 
under the circumstances. 



EDITORIAL DEPA^Ti^Ei^T. 
PERISCOPE. 

EPIDEMIC JAUNDICE. 

In the October number of the Maryland and 
Virginia Medical Journal, Dr. Thomas Pollard, 
of Eichmond, Va., gives an account of "Ende-~ 
mic Jaundice'^ occurring in Eichmond, Va. 
The following is a synopsis of the endemic as it 
occurred : 

" The cases occurred in this city in the 
month of June last, at the stable of Mr, Bos- 
sieux, situated between 20th and 2l8t streets, 
fronting on the Dock. The first cases which 
were treated there occurred in May last. Most 
of them were attended with fever, furred 
tongue, and generally constipated bowels. Oe- 



40 



PEEISCOPE— EDITORIAL 



[Vol. V. No. 2. 



curring in the first warm weather in May, in 
connection with the locality of the stable near 
the water, the somewhat apparent remission in 
the fever, caused them to be mistaken for re- 
mittent fever — though some of the marks of 
remittent fever were absent. They were treated 
with calomel and quinine. In a few days, per- 
haps in a week, in most of the cases, (five in 
number,) yellowness of the conjunctiva began 
to be observed, and the true nature of the dis- 
ease was then first discovered. In connection 
with the symptoms just mentioned, the urine 
was found colored with bile, the spirits were 
much depressed, debility was marked, appetite 
gone, and the secretion of the liver deficient, 
and the passages dirt colored — such symptoms, 
indeed, as are usually found in this affection. 
Convalescence was slow, and the patients 
(likely negro men) were a long time on the 
sick list, considering the mildness of the symp- 
toms, and the fact that they were usually able 
to sit up or walk about a considerable part of 
the day — though, as before remarked, they 
complained much of debility. When the yel- 
lowness of the eyes and torpor of the liver be- 
came manifest, calomel was more freely used, 
and with good eff'ect. 

*' As the disease progressed, it assumed a more 
decided and worse form. One after another was 
taken down, and out of nineteen likely negro 
men seventeen of them had jaundice. A young 
white man employed about the stable also be- 
came a subject of the same affection.'' 

Dr. Pollard remarks that endemic or epide- 
mic jaundice is extremely rare, no account 
thereof being published in the Lancet, Medico- 
Chirurgical Review, American Journal Medical 
Sciences, and the Virginia Medical and Surgi- 
cal Journal. If our readers will turn to Vol. I, 
p. 251 of the Medical and Surgical Reporter, 
they will find the account of an epidemic of 
jaundice, by Dr. Wm. Pierson, Jr., of Orange, 
which occurred in that city in the fall of 1858, 
attacking at least three hundred persons, out of 
a population of about 7,000. 

An account of the same epidemic, from the 
pen of Dr. Wickes, of Orange, may be found in 
the Transactions of the Medical Society of the 
State of New Jersey for 1859. After resorting 
to various remedies. Dr. Pierson found quinia 
the most efi[icient remedy. By this " in almost 
every instance the attack was broken up in a 
few days ; whereas, without it, cases would fre- 
quently be prolonged for weeks." This leaves 
scarcely a doubt as to the malarious origin of 
the disease. 

Neither in the Orange epidemic, nor in that 
at Richmond, does it appear that a single case 
proved fatal, though in the latter, according to 
Dr. Pollard's account, in several cases, there 
was much delirium and prostration, requiring 
the use of stimulants, while convalescence was 
slow. Dr. Pollard also suggests that malaria 
may have had something to do with the de- 



velopement of the disease, as the stables were 
lying near the river. 

From the authorities quoted, it seems that 
epidemics of jaundice are on record as follows: 
Occurring at Minorca, in 1746. 

at Cronstadt, in 1784-85. 
" at Geneva, in 1814. 

at Philadelphia, in 1824. 
" at Montgomery co.. Pa., in 1857.(?) , 

at Orange, N. J., in 1858. 
" at Richmond, Va., in 1860. 

It is very probable that endemics of jaundice 
are of much more frequent occurrence than is 
thought. 



aromatic sulphuric acid in the treatment of 
tapeworm. 
Dr. Darrach, of Quincy, Illinois, reports, 
in the American Journal of Medical Sciences, five 
cases of expulsion of tapeworm by the adminis- 
tration of aromatic sulphuric acid. In one of 
the cases, a fluid ounce of the acid in a pint 
and a half of water was directed to be taken 
by the patient at his convenience. In other 
cases, three drachms of the acid were given 
during the twenty-four hours. 

The remedy was used at the suggestion of Dr. 
Nichols, whose attention was first called to it 
by a woman who suffered from tapeworm, and 
who, on feeling its irritation gave it, as she said, 
" the sourest thing that she could find," and 
thus destroyed the worm. 



THE MEDICAL AND SURGICAL REPORTER. 



P niLADELPHIA, SATURDAY, OCTOBER 13, 1860. 

EXPERIMENTAL PHYSIOLOGY. 

Not unfrequently the remark is heard, even 
in high quarters, that experimental physiology, 
as now introduced, almost universally, in the 
most celebrated schools of the Old World, and 
as successfully taught in a few institutions of 
this country, would, after all, be but a loss of 
time should it be generally introduced into the; 
curriculum of studies in our cis-atlantic schools. 
Why should hour upon hour be spent in making 
observations and seeing phenomena which have 
been fully established and been repeatedly ob- 
served, when, without these time-taking vivisec- 
tions and experiments, the teacher might state 
the facts as well ? The office of lecturer, it is 
said, is rather to generalize, to expound the 
laws of life, health, and disease, than to waste 
time in the fascinating, perhaps, but tedious 



October 13, 1860. 



EDITOEIAL. 



41 



process of detailed experimental physiology, 
which may be accompanied in the lecture-room 
with a great deal of eclat, but, after all, stands 
a great deal lower in the scale of science than 
the task of generalization and expounding of 
physiological laws. 

Such, or similar arguments, are not unfre- 
quently advanced from quarters entitled to the 
highest respect ; and this is one of the reasons 
why the subject should be submitted to a calm 
and careful consideration. The other is, because 
physiology is bound to become the scientific 
basis of pathology and therapeutics, and hence 
it becomes a question of very serious import- 
ance, which is the best way of teaching it ? 

Now it must be acknowledged, that, in all 
physical sciences, (and medicine is the grandest 
of them all,) the very best method of teaching 
is the demonstrative method. It takes a student 
five minutes, perhaps, to read that the fifth 
pair of nerves emerges from a certain portion 
of the pons varolii, forms the Casserian gang- 
lion, divides into an ophthalmic superior and 
inferior maxillary branch, which are again sub- 
divided into certain ramifications which supply 
certain parts. Item, it takes up a whole hour 
to demonstrate properly on the cadaver these 
same points, and days or weeks to dissect them 
out carefully. But who will deny that the pro- 
per study of this part of our science is the de- 
monstrative and experimental study ? Is it really 
a loss of time to demonstrate and dissect ? 

The absurdity of such an assertion, were it 
really made in earnest, is too glaring to demand 
serious refutation. 

Now let us for a moment turn eur attention 
to the physiology of these nerves, and see how 
didactic "generalizing" teaching fares in com- 
parison with experimental physiology. In the 
former — which has well been stated to differ 
from knowledge derived from books, only by the 
latter being " to read one's-self," and the other to 
*' being read to" — an hour is, perhaps, spent in 
discussing the effects of paralysis or division of 
certain portions of these nerves, and their ef- 
fects upon the parts supplied by them, and 
for better illustration models and plates are, 
perhaps, used. But we doubt whether the stu- 
dent will be able to obtain the same amount of 



knowledge as if the action of these nerves, by 
irritation or division, were immediately demon- 
strated by vivisection, which could conveniently 
be done in an hour's time by an expert operator 
who possesses the faculty, indispensable to a 
teacher, of commenting upon the subject under 
consideration while carrying on his manipula- 
tions. 

The difi'erence between teaching physiology 
didactically and experimentally, is just the 
difference between an engraving and the real 
form — between a photograph and the object 
itself. It is true, as modern art has suc- 
ceeded in the stereoscope — a sort of artificial 
squinting-apparatus — in presenting planes in re- 
lief, so, by straining our mental eye to the neces- 
sary obliquity, we may imagine that we behold 
reality when we are merely looking at its shadow. 
This will do well enough when the former can- 
not be obtained. A man may roam by aid of 
stereoscopic delusions in an hour's time through 
sceneries and countries that it would take him 
a year to travel through, and he will avoid being 
bored by dull waiters, the dangers of the sea, 
dusty rides, and other discomforts of a journey. 
But would any man call this traveling ? It 
would be a strange fancy, indeed, if one should 
prefer reading a traveler's guide, however well 
written, to the journey itself, however tedious. 

If not in every department of human under, 
standing, the principle of Locke, " nil in intel- 
lectu, quod non prius fuerat in sensu" — is cer- 
tainly true in medical science, and one which, for 
the sake of successful medical teaching, should 
be hung up in letters of gold, conspicuous to the 
eye of both teacher and pupil. A little boy 
will run away from his picture-horse, if you 
show him one of tin, which has the three di- 
mensions ; but he will throw away both, to get 
a good sight of a real, prancing, snorting, gal- 
lopping, live beast. And not a whit different is 
it with the acquisition of knowledge among the 
wisest of men. The substance is always more 
acceptable than the shadow. 

But it might be, and it is often replied, that 
it is not necessary to demonstrate physiological 
facts, which have long ago been demonstrated 



42 



EDITORIAL. 



[VoL.V, No. 2, 



as perfectly true. A single glance will show 
the fallacy of such a reply. 

Take, for instance, the glycogenic functions 
of the liver, the artificial production of diabetes, 
or of cataract ; all facts which elucidate very 
important functions, and tend to explain many 
morbid conditions of the economy. Now, it is 
said by the opponents of experimental physiolo- 
gical teaching, that inasmuch as the glycogenic 
function of the liver, the artificial production of 
diabetes, and of cataract, are phenomena, or 
facts, perfectly well established, what is the use 
of encumbering our lectures with experiments 
to verify them ? We would answer this ques- 
tion by asking, what is the use of showing in 
our chemical lectures, year after year, by actual 
experiment, that water is composed of oxygen 
and hydrogen, when these last seventy years the 
fact has been perfectly well established ? Why 
are we, year after year, demonstrating by actual 
dissection that the sartorius muscle arises at a 
particular point to be inserted into another, 
when these last three hundred years the fact 
has been patent to all ? Why are we, year after 
year, encumbering the lecture room, and crowd- 
ing amphitheatres of hospitals with patients, 
to spend hours and hours in simply demonstra- 
ting, what has been known these many years, 
that when a man's chest is full of fluid, there 
is a dull sound on percussion, and a splashing 
OQ succussion ? Why spend valuable days in 
demonstrating well established facts, which 
could be taught didactically in so many hours ? 
It is, of course, unnecessary for us to answer 
these questions, which we have put, merely to 
show the inconsistency of the plea against in- 
troducing experimental physiology into the regu- 
lar curriculum. But, as really the only objec- 
tion raised against it, is because of its encum- 
brance and waste of time, we shall devote a few 
words to this. There is nothing more certain 
than that with the demonstration before his 
eye, the pupil is enabled to understand any truth 
or fact in half the time, at least, than if he were 
forced to draw off from the didactic teaching, 
part of his attention to supply the want of the 
former by his imagination. We had been read- 
ing, and we had been " read to" about the 



reflex action of the nervous system, for days 
and weeks didactically ; but we really never 
understood the subject thoroughly, until we 
witnessed a few simple experiments of Marshall 
Hall, and then we understood in ten minutes, 
what we had previously attempted to learn in 
vain. So it is with all departments of physio- 
logy — from digestion to secretion, from excre- 
tion to generation. 

Another point must be taken into considera- 
tion, and one of no little importance. If experi- 
mental physiology is made the rule of medical 
teaching, the student will be less encumbered 
with untenable and mere speculative theories, 
because the teacher will be careful not to state 
what he cannot satisfactorily demonstrate by 
experiment. It is unfortunately but too often IT 
the case that in didactic teaching generalizations 
take flight so fast that facts cannot follow, and 
fortunate the pupil who has mental ballast suf- 
ficient to keep him down to the latter. 

It must be claimed for experimental physiolo- 
gy, that it is the only true method of teaching 
that branch, as it should be pre-eminently 
demonstrative ; and further, that it will save tim« 
to the student, because it will obviate long ex- 
planations, which at best can elucidate the sub- 
ject but approximately ; and lastly, that it will 
purify physiological teaching from much rub- 
bish and trash, because the experimental teacher 
will not state as facts what cannot be proven 
by the demonstrations of science. 



DEATH FEOM CHLOROFORM. 

Another death from Chloroform is reported 
in the Gincinnati Lancet and Observer^ by Dr. 
Krause of Cincinnati. It occurred during an 
operation for iridectomy. The following is an 
abstract of the case in Dr. K's own words : 

** On the 25th of last month I performed an 
operation for artificial pupil, on a farmer, 29 
years of age, who had generally enjoyed good 
health. About a year ago he suffered from 
protracted intermittent fever. The disease of 
his eyes dated from this time. His constitution 
was scrofulous anaemic. Preparatory to th« 
operation chloroform was administered on a 
folded cloth, by an assistant suificiently expert 
in its use. The patient, who had been enjoined 



October 13, 1860. 



EDITOEIAL. 



43 



to keep his stomach empty on the morning of 
the operation, inhaled the chloroform in the 
recumbent posture, from 11 to about 11 J o'clock. 
He took one and a half ounces of it without re- 
sistance ; nor did he even manifest the usual 
ecstatic symptoms. I finally proceeded with 
the operation, after having three or four times 
desisted from it, on account of the patient's 
restlessness whenever the lid-holders were ap- 
plied. Previously, however, the removal of the j 
chloroform was ordered from the patient's 
mouth and nose, as his breathing had begun to 
be stertorous. The operation, iridectomy, lasted 
about five minutes. The anterior chamber of| 
the eye partly filled with blood, which I was | 
about to let out, when I noticed a sudden pale- j 
ness of the anterior ciliary vessels, which had 
become injected under the touch of the instru- 
ments. Then I found that the patient had 
ceased to respire, while the action of his heart, 
though weak, was still perceptible to the ear, 
regular, and about sixty beats in a minute. Ice- 
water, sprinkled into the patient's face, on his 
chest and epigastrium, had no effect. Ehyth- 
mical depression of the abdomen also failed to 
restore respiration. I therefore resorted to 
Marshall Hall's method. Windows and doors 
were opened, the patient's mouth and throat 
cleaned from a very tenacious mucus, which 
was not prone to discharge by its own gravity, 
and peripherical circulation promoted by rub- 
bing of the extremities heartward, the occa- 
sional use of ice-water and clapping of the skin. 
The function of tl^e heart was sustained by 
these means nearly an hour. Eespiration, 
however, which had occurred at first about 
once every minute a few times, gradually les- 
sening the patient's livid complexion, became 
less frequent and more superficial, until it de- 
generated into mere pseudo-pnoic efforts. There 
was during the agony a twitching of the mus- 
cles about the mouth, and a drawing up of the 
patient's legs : then pulsation also stopped. 
We ceased our efforts at resuscitation one hour 
and a quarter after the first symptoms of apnoea 
had appeared. 

No post mortem examination was made. The 
deceased had never complained of anything in- 
dicating disease of his thoracic organs. His 
size was over six feet, the configuration of his 
chest normal. During my short acquaintance 
with him his spirits were depressed, his temper 
torpid." 

There is no comment necessary. So rapidly 
4 



are the cases accumulating, showing the often 
unavoidable fatality of chloroform, that here- 
after the administration of chloroform, except in 
cases where ether has absolutely failed, must be 
considered as a sign of recklessness or igno- 
rance. 

**m** 

At a recent meeting of the Sanitary Associa- 
tion at New York, the committee, consisting of 
Drs. Percy, Batchelder, and Roberts, who had 
been appointed, as noticed in a former number 
of the Reporter, to investigate a case of poison- 
ing, and of criminal carelessness and violation 
of the law on the part of a druggist in West- 
Broadway, made their report. The facts therein 
brought to light do not differ essentially from 
those previously stated. The Association passed 
a resolution that the report be placed in the 
hands of the District Attorney, and that this 
gentleman be requested to prosecute the guilty 
parties. This is the wisest course that could 
possibly have been taken, and we only hope it 
it will be of avail, which it undoubtedly will be, 
if the District Attorney does his duty. 



SPIRIT OF THE MEDICAL PRESS. 

The Lancet, of September 15, treats its readers 
to a leader on the necessity of inventing an ap- 
paratus by which cereal crops maybe artificially 
dessicated, so that wet weather will no longer 
be permitted "to afflict the whole agricultural 
community with a general paralysis." It sug- 
gests for this purpose heated air with forced 
ventilation. 

Another editorial in the same number is de- 
voted to the Parliamentary Report of the Select 
Committee on Lunatics, in which the commit- 
tee virtually recommend that the office of the 
two medical visitors of the Court of Chancery be 
abolished, and their duties transferred to the 
Commissioners in Lunacy, so that instead of 
five medical officials, the increased duties of 
visitation will be discharged by three. The 
Lancet opposes the report. 

A practical subject discussed by the Lancet 
refers to the prevention of poisoning by mis- 
take. It is suggested that all bottles, con- 
taining potent medicines, such as laudanum, 
Fowler's solution, colchicum wine, etc., should 
have a narrow neck, which, from its causing 
the potent fluid or powder to drop slowly, in- 



44 



COREESPONDENCE. 



Vol. V. No. 2. 



stead of running in a full stream, could not fail 
to attract tlie attention of tlie manipulator. 

The Medical Times and Gazette has a someAvhat 
humorous article on physical training, referring, 
of course approvingly, to the " Rifle-movement.^' 
It says : " How much damnatory dyspeptic 
divinity we hear from the pulpit, though we are 
almost sure to find a good catholic spirit beam- 
ing in a man who knows how to train himself. 
The unmanly visionists of the speculum would 
have seen fewer phantasmagoria through their 
tubeS^and so have saved our women from their 
temporary Gallic degradation, if they had had 
their eyes earlier and oftener on an English 
rifle." 



Collusions between Physicians and Apothe- 
caries. 

Philadelphia, Oct. 9th, 1860. 
Messrs. Editors : — The writer has read with 
much interest, in your last, the communication of 
your correspondent ''Esprit de Corps,^' under 
the caption " dishonorable mercenary arrange- 
.ments between physicians and apothecaries.'^ The 
practice alluded to is certainly most disre- 
iputable, and ought to, and we are sure will, 
be discountenanced by every honorable and 
•high-minded physician and pharmaceutist. 
Some twenty years ago, we heard it openly 
whispered that this evil then existed to an 
alarming extent. It was, however, by no 
means, then confined to "suburban'^ locali- 
ties, but it prevailed in the very heart of 
the city, among the " best" and most respec- 
table apothecaries, and among some of our 
•most distinguished and influential physicians 
and surgeons. In this age of "progress" and 
"reform," when the ethics of the profession 
are generally better understood, appreciated and 
observed than formerly, the writer was not 
aware that any medical man, making the least 
pretention to respectability, would be guilty of 
such a dishonorably collusive arrangement. 
It evidently disqualifies every one " from be- 
coming or remaining" a member of any of our 
: medical organizations, and is a direct violation 
i of the spirit of the Code of Ethics of the Ame- 
rican Medical Association, which is alike bind- 
ing on every member of the profession, whether 
he is in fellowship with a medical society or 
not. The 3d section of Article III, of the Con- 
stitution of the "Philadelphia County Medical 
Society," expressly says : " Any physician, who 
■X- * * -X- * * ghall enter into a collusive agree- 
ment with an apothecary to receive pecuniary 
compensation or patronage for sending his pre- 
scriptions to said apothecary, ^ ^ ^- * * * shall 
be disqualified from becoming or remaining a 



member." A similar provision is contained in 
the Constitution of the "Northern Medical As- 
sociation of Philadelphia." The " Ordinances 
and By-laws" of the College of Physicians are 
not quite so explicit on this point ; yet its 
spirit and object, as well as its Code of Ethics, 
which is the prototype of the American Code, 
are so decidedly averse to everything that has 
the least tendency to bring dishonor on the 
profession, that no one known to be guilty of 
such a vice could gain a footing, or be tole- 
rated, in that venerable body. If, therefore, 
the party complained of is a member of either 
of these organizations — and almost every re- 
spectable practitioner at the present day is 
associated with one or the other — '^Esprit de 
Corps'' could do the profession and its ethics no 
greater service than to prefer a formal charge 
against him to the Censors of the Society to 
which he belongs, and, our word for it, the in- 
fraction will receive due and merited attention. 

The remedy suggested for breaking up such 
mercenary collusions is a good one, and if 
faithfully carried out, would certainly prove 
most eflectual. Let, therefore, every respect- 
able practitioner, who desires to do right, with- 
hold his support and encouragement from every 
unworthy apothecary, who is known to be 
given to this practice ; and, in addition, let the 
community know why he does not wish his prescrip- 
tions compounded at such establishments. If the 
profession could be induced to act harmoni- 
ously, unitedly and determinedly in this mat- 
ter, this evil could thus soon be completely 
eradicated. 

This subject also furnishes another and a 
most important argument in favor of general 
organization, both as regards the medical and 
pharmaceutical professions ; and a powerful 
incentive why every honorable physician and 
pharmaceutist, who love the honor and dignity 
of their respective callings, should heartily co- 
operate in the all-important work of organi- 
zation. 

If both the physician and apothecary were 
members, as they ought to be, of the organiza- 
tions established for the protection of the inte- 
rests of their respective professions, to whose 
laws and ethics they were held rigidly amena- 
ble, it would be easy to remedy the evil. But 
in the cases which have called forth the just ani- 
madversion of "Esprit de Corps," it may be 
that neither the physicians nor the apotheca- 
ries are responsible to any such tribunal ; for, 
especially as regards the latter, he leads us to 
infer that they are neither "the best nor the 
most deserving of patronage." This is an im- 
portant consideration. From our personal ac- 
quaintance with, and knowledge of, many phar- 
maceutists in different sections of the city, we 
cannot believe that any honorable and respecta- 
ble member of that profession would be willing 
to lend himself to such a base and dishonorable 
agreement. On the contrary, we know that 
their ethics, like our own, strictly forbid it. We 



October 13, 1860. 



COERESPONDENCE. 



45 



quote from the Code of Etliics of the Philadel- 
phia College of Pharmacy as follows: — " We, 
in like raaymer, consider that an apothecary being 
engaged in furthering the interests of any par- 
ticular physician, to the prejudice of other repu- 
table members of the medical profession, or al- 
lowing any physician a per centage or commis- 
sion on his prescriptions, acts unjustly toward 
that profession and injuriously to the public.'' 

I may, in the interpretation that follows, 
do "Esprit de Corps" injustice; but the infer- 
ence from his communication is, that the " sub- 
urban neighborhood,'' to which he thinks this 
practice is confined, is in the northern section 
of the city. However this may be, most of the 
reputable practitioners in that section are mem- 
bers, and many working members, of one or the 
other or of several medical societies, for whom, 
as a class, we claim, until the contrary is 
shown, equal " loyalty" to the " code," as may 
be claimed for those from any other section. 

In conclusion, Messrs. Editors, I desire yet 
to say, that no one is in a position to do more 
toward correcting such great evils, and dissemi- 
nating healthy ethical views among the pro- 
fession here than you of the Reporter, which 
seems to be a welcome weekly visitor to the 
office of almost every medical man in this ever- 
growing "metropolis of medical science," and 
it is hoped you will continue to speak out 
boldly, and expose in unsparing terms this great 
mercenary disgrace to the reputation of our time- 
honored profession. 

Esprit des Lois. 



THE ESTHETICS OF PILL MAKING. 

Philadelphia, Oct. ^th, 1860. 

The modern improvements in the prepara- 
tion of officinal articles by extracting active 
principles from crude materials, and concen- 
trating them, or freeing them from extraneous 
substances, tend to facilitate their administration 
by reducing the bulk. As in the pilular form 
medicine is not supposed to be tasted, upon the 
size of the pill depends the desirableness of this — 
as it ought to be — most eligible form of dose. 

Many radicals and other concentrated prepa- 
rations, the usual doses of which are but frac- 
tions of the grain, are capable of being given in 
the granular or minute pilular form, without 
losing any of their efficiency, and with certain- 
ly more consideration for the fastidiousness or 
delicacy of patients. Notwithstanding the mani- 
fest advantage of the diminished bulk in which 
medicines are now found, the benefit of it 
seems, from custom, not usually taken advan- 
tage of by the pharmaceutist in the preparation 
of pills. It this city, the model size of the pill 
seems to be that which is turned oflT by the old 
fashioned " pill machine.^^ In bulk such pills 
are large, and vary in weight from three to five 
grains, according to the density of their compo- 
nent materials. 



Habit appears to have made pills of this size 
the usual form, and it matters not how diminu- 
tive the bulk of the article ordered, enough of 
some cohesive material is added to make each 
pill of a size to suit the druggist's convenience 
in preparing, or, perhaps, his beau ideal of the 
proper size of a pill. Thus such articles as 
strychnia, atropia, etc., in their usual diminu- 
tive doses, when ordered to be dispensed in 
the pilular form, very frequently appear before 
the patient almost as a bolus. 

Most practitioners are not in the habit of di- 
recting the amount of matter to be added to 
make the mass of a proper bulk, or to aid in 
the subdivision of the medicine, but leave it 
to the discretion of the pharmaceutist, intend- 
ing that he shall add no more than is really 
necessary. 

All that I desire by this note is to call the 
attention of druggists to an annoying habit to 
which some of their fraternity are addicted, of 
making up pills of a size which is often repul- 
sive to patients. XX. 



Dry Summers and Health ; Van Bibron's Anti- 
dote ; Enlarged Spleen and Malarial 
Cachexia. 

Warsaw, Ala., October 1st, 1860. 

In the transactions of the American Medical 
Association, of several years since, it was laid 
down as a rule, that " dry summers are sickly 
ones." The present summer has proved an 
exception to this general rule for a scope of 50 
miles around us. It has been unusually dry, 
and unusually healthy. I have noticed that 
since the dry season set in, that among women 
there has been an unusual tendency to abortion 
at about the period of quickening, and mani- 
fest irregular action at any stage of pregnancy, 
sufficiently so to become very noticeable to a 
physician. 

I put "Bibron's Antidote" to the test, some 
time back, in a case of rattlesnake bite, with 
complete success, the first dose giving almost 
complete relief to the distressing pains, and 
quieting the delirium. 

The fall, so far, has been very dry, and, as a 
consequence, what few cases of fever we have, 
are assuming the congestive form, choleraic 
variety. 

I send you a prescription of Dr. Gadbury, of 
Miss., which, I do not think, has ever attained 
publicity, exceedingly ubqAxI in cases of enlarged 
spleen and malarial cachexia. 

R Liquor ferri. sulphatis, f. '^ ss. 
Quinge sulph. ^i. 

Aqu^ cinnam. f. 5 viij. 

Mix and add Potassse citrat. 5 ij. 

Sig. Take a tablespoonful three times daily. 
Apply Iodine ointment over the splenic region, 
and a flannel bandage around the abdomen. 



46 



NEWS AND MISCELLANY. 



Vol. Y. No. 2. 



To make the liquor ferri sulpliatis : 
R Ferri. sulph. gss. 

Acid nitrici, f. ^ iij. 

Aquae, f, ^ iss. 

Eub the iron and acid together for 15 min- 
utes, then add the water. 

Edward H. Sholl. 



NEWS AND MISCELLANY. 

Introductory Day. — As previously announced, 
the Introductory Lectures in our three Medical 
Schools were delivered on Monday last, and the 
halls of each institution were crowded with stu- 
dents and physicians. 

Professor Carson delivered the Introductory 
at the Medical Department of the University of 
Pennsylvania, at 12 o'clock M. 

After welcoming the students to this seat of 
learning, and, on behalf of the Faculty, extend- 
ing a cordial greeting, Professor Carson alluded 
to the change, inaugurated for the first time on 
this occasion, of having but one introductory 
lecture, as one of advantage, as it saved an un- 
necessary expenditure of time, and allowed the 
student at once to engage in his studies. He 
then proceeded in earnest and eloquent language 
to counsel the student as to the proper way in 
which to prosecute their studies. 

The study of medicine does not consist in 
memiorizing axioms, but in accumulating facts 
and applying them. The prosecution of the 
science of medicine may be laid down in rules : 

First. Lay a good and deep foundation. No lofty 
and enduring structure can be reared without a 
solid and substantial foundation. Hence the 
strictly demonstrative ^nhlQci^ should be the ones 
first to engage the student's earnest attention. 
The perceptive powers are thereby exercised, 
and the student acquires an ability to employ 
his senses correctly, which is indispensable to 
physicians, and can never be supplanted by 
mere intellectual reasoning. He who has ac- 
quired the faculty of perceiving and using his 
senses correctly is not so liable to make errors. 
It is from a want of paying proper attention to 
the demonstrative branches of our science, that 
it is true what Gregory the elder has said, that 
medical science is crowded with facts which 
never had an existence but in the brain and 
imagination of the men who advance them, and 
from this want spring many of the false theories 
of empiricism and charlatanism of our day. 

But besides the immediate advantages which 
they yield, the demonstrative branches of medi- 



cine imbue the student with a taste for positive- 
ness which will afterward save him from many 
false theories and erroneous practices. We are 
astonished at the zeal with which the ancient 
sculptor must have prosecuted his task when he 
produced, in the most detailed, anatomical cor- 
rectness, the statue of the dying gladiator ; and 
shall ours be less with the design to allay suf- 
fering and dispense health among our fellow- 
men? 

Secondly : Proceed methodiccdly , — The truth and 
importance of this rule will be at once recogni- 
zed. Order is nature's first law. Proceed to a 
higher branch, only after you have mastered 
the lower, bearing in mind, that in scientific 
acquirements, as well as in nature, there is a 
natural transition. Unflinching perseverance 
with methodical study alone, lead to intellectual 
power and greatness ; and remember that the 
bird, which flutters most soonest gets tired, and 
that a steady flight accomplishes the greatest 
distance. 

Thirdly: Proceed with necessary deliberation. — 
Nothing is more harmful in study than hurried 
movement. It is true, in our country every- 
thing is done hastily. The many channels of 
business enterprise, and the rapidity with which 
fortunes are made and lost, and the erratic and 
speculative tendencies that characterize our age 
and country have left their impress even upon 
our educational system, and hence the com- 
plaint, so frequently made of the superficiality 
of our learned professions, which has been a pro- 
lific source of charlatanism and empiricism. 
To obviate these evils we must act with delibe- 
ration. Eapid progress is not permitted in science. 
There must be time for assimilation. The sys- 
tem of over-study, as it is not unfrequently 
seen, acts, as a student once happily expressed 
it, by displacement; while learning one fact, 
another is forgotten. This is not the right sys- 
tem. We have not yet arrived at the age of 
intellectual power-looms, reaping machines for 
medical science, and condensing apparatuses of 
knowledge. The idea advocated in some quar- 
ters that the present term of study is too long, 
and that passing a certain prescribed examina- 
tion should be the only requirement for a de- 
gree, is justly considered as erroneous by the 
best informed and the highest authorities in the 
profession throughout our country, who, on the 
contrary, hold, that the present term of three 
years is not sufficient for a thorough medical 
education. Some of the accessary branches, as 
botany and geology have been too much neg- 



October 13, 1860. 



NEWS AND MISCELLANY. 



47 



lected, much, to tlie disadvantage of the profes- 
sion. Botany should be at least so far intro- 
duced in our system of medical teaching as to 
enable the student, when he leaves the college, 
to make the productions of the soil in the lo- 
cality, where he settles, tributary to science ; 
the same is true of geology, v/hich may enable 
us in time to unmask disease and its causes. 

After paying a beautiful tribute of respect to 
Dr. GrEORGE B. Wood, who for twenty-five years 
had so ably filled a place in the faculty of the 
University, and whose scientific labors have shed 
lustre upon the institution, the city, and the 
profession of our country, Prof. Carson, in 
very becoming language, alluded to the appoint- 
ment of Dr. Pepper, one so eminently worthy 
to be Dr. Wood's successor, on account of his 
large experience, eminent scientific acquire- 
ments, and great capacity as a clinical teacher. 

Prof. Carson concluded his address, which was 
eloquently delivered and frequently received 
with applause, by exhorting the students ear- 
nestly to labor in the great task before them, 
that of learning the science of medicine, to 
make themselves masters of the healing art, 
and thus not only to become valuable citizens of 
the commonwenlth but benefactors of our race. 



Professor Dunglison opened the course in 
Jefferson College, with a discourse on Medical 
Methodology, which was listened to with great 
attention. He alluded to the rapid advances 
which medical science had made in the last 
fifty years. Histology is almost a new science. 
Physiology has entirely changed. Grermany, 
France, and the Anglo-Saxons have all contri- 
buted to the elucidation of new facts and laws 
in reference to the great questions of life. Yet, 
however valuable and indispensable it may be, 
to resort to actual experiment and vivisections 
to interpret the phenomena of life, after much 
and serious deliberation it had been found best 
not to encumber a course of didactic teaching 
of physiology with experiments and vivisec- 
tions, which would, although accompanied with 
eclat in the lecture-room, only be a loss of time. 
The course of lectures on this branch of science 
should rather be to expound the laws which 
have been elucidated by experimental physio- 
logy. 

Professor Dunglison then reviewed the great 
improvements which have been made in all de- 
partments of medicine ; in surgery, which has 
become more and more conservative ; in che- 
mistry, to which we are indebted to the most 



valuable discoveries ; to materia medica, which 
has become simplified. Public and private hy- 
giene has been improved. In reference to medi- 
cal jurisprudence, much is yet to be accom- 
plished, and it has been a matter of much 
consideration in what manner this could be best 
accomplished in the present curriculum of stu- 
dies. The chair of medical jurisprudence had 
frequently been added to that of obstetrics, be- 
cause some of the important questions of legal 
medicine, such as infanticide, abortion, etc., ap- 
pertained more particularly to obstetric science. 
Yet, it must be considered that legal medicine 
occupies a much wider sphere, embracing in its 
scope more or less all departments of medicine, 
and for this reason had frequently been added 
to the chair of institutes of medicine. By 
others, however, it is thought that it would be 
sufficient for the student to devote himself to a 
study of this branch after graduation, and this 
suggestion is not without force, as in any case, 
when the physician is called upon, it is neces 
sary for him to prepare himself and study up 
the particular questions of the case in which he 
is called to give an opinion. 

In reference to preliminary education, he 
would exhort the students to do all in their 
power to sustain the medical as one of the 
learned professions ; for, although it would be 
unwise under existing circumstances, to demand, 
as absolutely necessary any particular standard 
of preliminary education, a liberal education is 
indispensable to the progessing status of the 
profession.. 

In reference to the proper way of conducting 
their studies, Prof. Dunglison gave the students 
some most excellent rules. He would especially 
advise those about to graduate at the end of the 
term, not to undergo that process commonly 
known as ' ' cramming.^' A student who had been 
" crammed" often resembled a warehouse, well- 
stocked, but without order and system ; every- 
thing may be there, but it cannot h^ found when 
wanted. 

After dwelling upon some of the delusions 
of the day, and their causes, and giving some 
of the ludicrous, so called " provings" of ho- 
moeopathy, Prof. Dunglison concluded with an 
earnest exordium to the class to enter upon their 
studies with energy and zeal, and to do credit 
to themselves and to the profession. 



At the medical department of Pennsylvania 
College Prof. Henry Hartshorne, delivered the 
introductor}^ Dr. Hartshorne 's lecture was 



48 



NEWS AND MISCELLANY. 



Vol. V, No. 2. 



upon "Speculative and inductive medicine." 
After alluding to the importance of the estab- 
lishment of the inductive method of studying 
nature, by Bacon and others, in the 16th cen- 
tury, a condensed account was given of the 
principle phases and mutations of medical opin- 
ion and theory, from antiquity to the present 
day. The most conspicuous systems or schools 
of medicine were described briefly, under the 
titles of Naturalism, Empiricism, Eclecticism, 
Humoralism, Solidism, Chemicism, Mechani- 
cism, Neuropathology, Stimulism, Vitalism, and 
Cellular Patholog3^ The great and extended 
influence of the Brunonian theory was explained 
chiefly by its affinity to vitalism; a form of which, 
chastened and matured by accurate science, the 
lecturer believed to be about to assume a pre- 
dominant place, superceding even the "cellular 
pathology." 

Dr. Hartshorne asserted his full confidence in 
rational empiricism as the true and only sound 
basis of therapeutics ; distinguishing it care- 
fully, of course, from unscientific and unsys- 
tematic empiricism. Physiological reasoning 
cannot guide therapeutics, at least until physi- 
ology is perfected. Almost all important reme- 
dies have been discovered by accident, and often 
have had to contend for a time with opposition 
from theorists. To place therapeutics upon the 
foundation of clinical observation, is to make 
it eminently rational and scientific. The two 
blades of the scissors of practical medicine are, 
diagnosis and clinical proof . Yet, as medicine is 
progressive, and as pathology is necessary to 
diagnosis, and physiology indispensible to path- 
ology, these sciences must contribute essen- 
tially, in their advancement, to that of the 
practice of medicine. In the other natural 
sciences, however, facts and details are, at the 
present time, abundant; generalization and re- 
flection are, in them, as Agassiz has recently re- 
marked, now most required. But it is not so in 
medicine ; which needs more fact, and less theory ; 
more exact and extended observation of the his- 
tory of disease and of the action of remedies. 
Allusion was made to the writings of Dr. Bige- 
Low, Sir John Forbes and others, calling atten- 
tion to the resources of nature in the cure of 
disease ; this being a revival only of the doc- 
trine taught by Hippocrates, Asclepiades, Cel- 
sus, Sydenham, and others. And now, when, 
although Dr. Bennett of Edinburg predicts the 
"approaching downfall of empirical practice," 
yet his co-laborer, the late Dr. Todd, in his last 
words, urges the importance of its support, in 



clinical research, and the philosophic medical 
historian, Eenouard, seconding the efforts of 
Louis the founder of the numerical method, 
foretells the coming triumph of rational empiri- 
cism or inductive medicine — now, when mor- 
tality statistics and life-assurance tables show 
that human life has been decidedly lengthened 
within fifty years, and hospital records prove 
that the results of medical, surgical, and obste- 
rical practice, grow better in the same propor- 
tion — ^now, when the dispassionate physician 
ought to find more reason than ever to confide 
in and honor his profession ; it is, nevertheless, 
the school of medical scepticism which makes 
the most clamor. Its representation by the 
"autocrat of the breakfast-table" was spoken 
of with regret, that so brilliant a writer should 
have strained the truth more than a hair's 
breadth, to use his own language, for the sake 
of epigram or antithesis. 

The lecture concluded with expressions of 
welcome to the class, and encouragement to 
enter with enthusiasm upon their labors. 



The attention of practitioners or druggists 
desiring a favorable location in this city, is di- 
rected to an advertisement ofi'ering an establish- 
ment for sale. 



Carvalho's Oxy-Hydrogen Retort and Steam Super- 
heater. — This is a new process of super-heating 
steam, invented by S. N. Carvalho, of Balti- 
more, Maryland. 

The great difficulty in all previous apparatuses 
for the purpose of super-heating steam and 
thereby increasing its elasticity and force has 
been i\iQ rapid destruction of the metal constitu- 
ting the heating tubes or chambers, in conse- 
quence of their oxydation from the exposure to 
high degrees of heat on one surface, and the 
gases of the decomposed steam within. 

The invention under notice removes this ob- 
stacle by the use of metallic substances within 
the retort, exposing a greater degree of surface 
to the steam and preventing the oxidation of 
the metal composing the retort — the process 
being analagous to that going on for the pro- 
duction of " iron by hydrogen" for medical pur- 
poses. 

This retort lessens the dangers from explo- 
sion of boilers, as more work can be done with 
half the ordinary pressure ; it produces double 
power with a great saving of fuel ; it supercedes 
the necessity of large and expensive boilers ; 
and in its application to steam vessels in addi- 
tion gives the vessel a larger space for freight. 

This apparatus can be attached to any boiler 
at trifling expense. 

It has been for several months in successful 
operation at the Navy Yard, at Washington, 



October 13, 1860. 



NEWS AND MISCELLANY. 



49 



D. C, and in several large establishments in 
Baltimore, and will soon be erected in the Navy- 
Yards of Boston, New York and Philadelphia. 
It has been attached to the steamers Georgiana 
and Louisiana of the Bay line, and it will soon 
be used wherever steam is employed. The Sci- 
entific magazines mostly speak highly of it, and 
the October number of the Eailroad Magazine, 
of New York, considers it one of the greatest 
inventions of the age, and probably the most 
valuable.'' 



Groioth of Nails. — In going round the wards 
of the Charite with M. Beau, a novice will be 
not a little puzzled at seeing him scrutinize 
closely the finger-nails of each newly-admitted 
patient, telling him occasionally, after a few 
moments' examination of his cuticular appen- 
dage, " My friend, you had a bad illness so 
many months ago, a very severe illness, that 
pulled you down a good deal ; and then you 
had a relapse," and so on. This sort of invert- 
ed palmistry puzzled me sorely at first, and I 
confess that even the explanation, when given, 
left me very skeptical as to the infallibility of 
this retrospective fortune-telling. Nevertheless, 
although I do not believe in Hume the spiritual 
medium, any more than in Hahnemann and his 
inicrodosic followers, I do believe in this sign 
of the pQ,st as indicated by the nails. If you 
look at the fingers of a man who had typhus 
fever three months ago, let us say, you will find 
on the nails, toward their centre, (at that in- 
terval of time,) a transverse furrow, deep and 
well marked, coinciding with the moment when 
the check in their nutrition occurred — the 
depth of the depression being in propertion to 
the severity of the illness, its breadth with the 
duration ; and the several consecutive relapses 
being each notched on the ungual appendices 
as on so many tally-sticks. — Lancet. 



A New Feature in a County Medical Society. — 
The Bradford County (Pa.) Medical Society 
have established a form of clinic in connection 
with the meetings of the society, the report 
of which presented in the transactions of the 
State society, says : 

" The idea of a clinic in a county society may 
appear somewhat novel to some ; nevertheless, 
it has thus far operated remarkably well in this 
society. By granting to the inhabitants the 
privilege of bringing obstinate and chronic cases 
before the society, en masse, to be examined and 
prescribed for, free of charge, has excited an in- 
terest and feeling in the community in favor of 
the profession that could not have been pro- 
cured in any other way, and, in fact, doing 
away the idea, before adverted to, that the meet- 
ings were for selfish and pecuniary motives ; 
and to the members they must of necessity 
prove beneficial, provided they are conducted in 
a proper and judicious manner, and that they 
may be, a physician and surgeon are appointed 
yearly to take charge of the clinics. The cases 



presented are only from the regular members ; 
a record of the disease, symptoms, and treat- 
ment, progress, and termination, is regularly 
kept. We would earnestly recommend them to 
the favorable notice of other country societies* 
Why may not clinics prove as beneficial out of 
cities as well as in V 



Life and Death in London. — A poor woman 
solicited the magistrate's advice, stating that at 
nine o'clock on Monday night a child of hers 
died of cholera, ever since which it had been 
lying in the same room in which her husband, 
herself, and two children were living. The 
parish had refused to bury it, and told her to 
do so on Saturday with her husband's wages ; 
but if she did that all of them must starve, and 
she knew not what to do. Mr. Paynter said 
" it was a very shocking case, as a pestilence 
might arise and be destructive to every one in 
the house, and others besides. It was very 
strange, but it seemed no one's duty to bury the 
body, and he doubted whether the parish could 
be compelled to do so. If it was any one's duty, 
it surely was theirs, but he could not compel the 
parish to bury it. He had no power whatever 
to assist her, and all she could do would be to 
consult the Poor-law Commissioners." — Dublin 
Medical Press and Lancet. 



The Pathological Museum of the Philadelphia 
Hospital. — At a recent meeting of the Medical 
Board of the Philadelphia Hospital, Dr. D. H. 
Agnew was appointed Curator of the Patholo- 
gical Museum. 

This appointment will insure the efficient 
management of the establishment. There is 
already a considerable fund appropriated for 
securing at once the fixtures and materials for 
the basis of a cabinet, and a yearly endowment 
will be granted for the purpose. To the libe- 
rality of the Gruardians controlling the hospital, 
the medical profession will be indebted for the 
beginning and sustaining, in an unequalled field 
for pathological study, a museum which will be 
a great scientific benefit. 



It is now pretty well agreed among the learned 
in every science, that the foundation of all true 
and solid knowledge must be laid in observa- 
tion and experiment. They are, indeed, the 
only substantial basis on w^hich we can surely 
venture to establish any kind of doctrine, and 
the surest tests whereby to try the validity of 
any philosophical system that comes before us ; 
for what do any modes of reasoning avail where 
facts and experiment are wanting in their sup- 
port ?— Dr. Shaw, 1755. 



An exchange paper says : — " Elder Kimball, 
one of the Mormon saints, had fourteen chil- 
dren born to him in one night." 

Those who believe in the uniform duration 
of the period of gestation will naturally retro- 
spect two hundred and eighty days. 



50 



NEWS AND MISCELLANY. 



Vol. Y. No. 2. 



Ph'dadelphia County 3fedical Society. — This so- 
ciety seems to be in a higlily prosperous con- 
dition. The second of the series of conversa- 
tional meetings was held on last Wednesday 
evening, at the nsual time and place, Dr. Re- 
mington presiding. These meetings, for scien- 
tific purposes, promise to be more than ordina- 
rily interesting and instructive this season. 
Some of our most learned, experienced, and 
eminent practitioners and teachers are expected 
to take part in the scientific proceedings. The 
subject for discussion on Wednesday evening 
was, ^'Opiv.jn as a Therapeutic Agent,'' and was 
ably introduced by Dr. Greorge Hamilton. An 
animated debate ensued, in which Drs. B. H. 
Coates, D. F. Condie, I. Remington, Wm. Dar- 
rach, E. P. Thomas, J. Chester Morris, and 
others, participated. We hope to be able, as 
usual, to furnish our readers, in our next, with 
Dr. H.'s paper, as well as the remarks of the 
several speakers. 

The next stated (quarterly) meeting, which is 
chiefly for business purposes, will be held on 
Wednesday afternoon next, at 3 J o'clock, when 
a number of new members will be elected, re- 
ports from the censors presented and considered, 
and nominations made for the ensuing year 
for officers of the society and delegates to the 
American Medical Association, and to the Medi- 
cal Society of the State of Pennsylvania, These 
nominations are made through two committees 
— ^the one appointed by the j)resident, and the 
other elected by the society, at the July meeting. 
These business meetings are often largely at- 
tended — especially the annual, at which, on a 
late occasion, there were 104 members prssent. 



regard to the strychnine in whisky. In a large 
number of whisky analyses, made during the 
past year, we have not been able to detect, in a 
single instance, the presence of the least trace 
of strychnine, and we have not been able to 
ascertain, from • any reliable source, that the 
practice of using strychnine in whisky is ever fol- 
lowed. The fact, also, that one part of strych- 
nine will impart a sensible bitterness to 600,000 
parts of water would seem to preclude its being 
used for that purpose. 



Humane Improvements in Slaugldering. — L' Union 
Medicale lately published a valuable report read 
at the general meeting of the Paris Society for 
the Prevention of Cruelty to Animals. In this 
document, are described several cruel practices 
which are of daily occurrence, both during the 
conveyance of the animals to Paris and the 
actual treatment of them at the slaughter- 
houses. It is to be hoped that this publicity 
will lead to the removal of the evils alluded to. 
Amongst the suggestions which the report has 
drawn forth, is one which deserves attention. 
M. Auber, of Macon, thinks that air injected or 
bloAvn into an opened vein would bring on in- 
stantaneous and painless death ; and grounds 
his belief upon the effect produced upon dogs 
and other animals by this mode of destruction. 
He adds, that it was customary with the French 
at Rome to kill in this humane manner horses 
unfit for further service. — Lancet, Aug. 4, 1860. 



Rape committed during Magnetic Sleep. — A case 
of this, recorded in La Presse Medicale de Mar- 
seille, is quoted in the Amer. Journal of Medical 
Sciences. A girl, 18 years of age, believing her- 
self to be sick, consulted a man who professed 
to cure diseases by animal magnetism. For 
some time she went to him daily. Atl:er about 
four months and a half she perceived that she 
was pregnant, and complained to the police 
authorities, who consulted Doctor Costa, Direc- 
tor of the School of Medicine, and Broquier, 
principal Surgeon, to give an opinion : 1st. 
Whether the girl was pregnant, and the period 
of utero-gestation, and, 2d. Whether she could 
be violated and made a mother against her will. 
These physicians ascertained that the girl was 
pregnant, and that utero-gestation had not ad- 
vanced further than four or four and a half 
months, and supported by the report made to 
the Academy of Medicine by M. Husson, in 
1831, concluded, since it is demonstrated that a 
subject under the influence of magnetic sleep is 
insensible to all tortures, it seems rational to 
believe that a young girl may submit to coition 
without voluntary iDarticipation in the act, 
without being conscious of it, and of course 
without being able to resist. This opinion is 
concurred in by M. Devergie, of Paris. 



No Strychnine in Wliishey. — At the meeting of 
the American Pharmaceutical Association of 
New York, on the 11th ultimo, a paper was 
read by Mr. Carney, of Boston, on the frauds 
and deceptions practised on the public by adul- 
terations of drugs. In one popular idea, how- 
ever, says the report, there is a great error — in 



Weight of Men.— li is stated that 4,369 men 
had been weighed at the Mechanics' Fair in 
Boston, and that their average weight was 146 
lbs. 13 ounces. The mean weight of men in 
Belgium (Brussels and its environs) is 140.49 
pounds. In France (Paris and the neighbor- 
hood), the mean weight is 136.89 pounds. In 
England (taken at Cambridge, between the ages 
of 18 and 28), the mean weight was found to be 
150.98 poimds. It would be a good idea,_ foun- 
ded on something more than mere curiosity, to 
have a good set of scales used at fairs in all 
parts of the country. 



Br. Livingsione. — The celebrated African tra- 
veler. Dr. Livingstone, is to have another 
steamer, which has been sent out by the English 
Admiralty, to enable him to proceed with the 
exploration and navigation of the Zambesi. 
The screw steam-sloop Pioneer, of 350 horse- 
power, has recently departed from Woolwich, 
fully laden with 'stores for the intrepid ex- 
plorer. 



October 13, I860.] 



NEWS AND MISCELLANY. 



51 



Case of Twins, one of ivJilch was horn enveloped 
in the Membranes. — The patient in this case was 
a negro woman. It is reported by Dr. E. W. 
Woodson, of Woodville. Ky., in \he October 
No. of the American Journal of Med. Sciences. 
The midwife, supposing the child to be dead, 
deposited it in a vessel without rupturing the 
membranes, and set it away until the doctor 
arrived, which was at least fifteen minutes after 
delivery. The rest we give in Dr. W.'s own 
language : 

"As soon as I entered the room she related 
what had happened, and presented the vessel 
for me to inspect. I at once ruptured the 
membranes and found the cord still pulsating. 
I removed the child and succeeded in resusci- 
tating it by using friction, artificial respiration, 
&c. I allowed the cord to remain untouched 
as long as it pulsated. The child was perfectly 
livid, and apparently dead when I commenced 
to work with it. The breathing was at first 
gasping and at long intervals, but finally be- 
came regular and quiet. The child lived and 
did well.'^ 



Adhesion of a Separated Portion of a Finger. — 
Azam relates an additional case in proof of the 
desireableness of attempting to secure the re- 
union of separated parts. A man while fash- 
ioning a piece of wood by means of a very sharp 
hatchet, chopped off an oblique slice of the 
index finger, three centimetres in length, the 
line of separation dividing the nail into two 
parts, and carrying away almost all the pulp of 
the finger. He fainted ; but a neighbor who 
came to his aid ten minutes after the accident, 
bound on the separated part, and the most com- 
plete union promptly followed. — Bull, de Therap. 
and Medical Times. 



Aneurisms in the Arch of the Aorta, says Dr. 
Baillie (1800), as well as in every other part of 
the arterial system, happen much more rarely 
in women than in men. This arises from two 
causes. The one is, that women, from their 
sedentary life, are less liable to an increased 
impetus of blood, occasioned by excited circu- 
lation; the other is, that the arteries in this 
sex appear to be less liable to these diseased 
alterations of structure, which predispose to 
aneurism. 



TJie Leavenioorth Times thus serves up Dr. 
Windship, the great lifting-athlete, comment- 
ing upon the statement that he had lately 
"lifted eleven hundred and fifty pounds, dead 
weight.^ ^ The Times advises Windship to stop. 
"Stop, Doctor! youTl get into trouble if you 
keep on that way. We knew a fellow once 
who got a habit of 'lifting' things — small ones 
at first — then larger, until at last he took to 
' shop lifting !' Consequently they sent him to 
the Penitentiary for five years. '^ 



Titles. — A clergyman, hearing that a college 
classmate, every way his inferior, had been 
made a Doctory of Divinity, is said to have 
remarked, "Years ago, when I saw them be- 
ginning at the top of the ladder to make doc- 
tors, I had no hope that they would get down 
to me ; but now they have begun at the other 
end, I think, may-be, they will get up to me." 
— The Century. 



A New Work by Dr. Hodge on diseases of 
females, is soon to appear. From the eruditon 
and practical experience of Dr. Hodge, the pro- 
fession will anticipate a volume which will be a 
valued accession to the subject to which the 
author has so uninterruptedly devoted himself, 
and so successfully taught. 

Sir Henry Holland was on Tuesday last enter- 
tained at a dinner with the Philadelphia Club, 
in company with some of the prominent medi- 
cal men of this citv- 



Dr. G. A. Peters has been elected Surgeon to 
the New York Hospital, in place of Dr. Van 
Buren, resigned. 



En5ix);erj? to ©orr^spcmlr^ntjef. 

Dr. W. S. — We have referred the plant you sent 
us to Prof. Carson, of the University of Pennsylvania, 
and received the following reply : 

The plant received from you yesterday is the As- 
clepias verticillata. It grows through the Middle and 
Southern States. It has not been put down in the 
books as medicinal, and yet I should think it might 
be similar in its action to the other species, which 
are regarded as active. I do not find that even Dr. 
Clapp, in his catalogue, published, some years ago, 
in the Transactions of the American Medical Asso- 
ciation, has alluded to it. 



Communications Received. — Alabama, Dr. E. H. 
Scholl — Delaware, Dr. D. W. Maull — Indiana, Dr. 
S. G. Reed, (with end.)— Iowa, Dr. E. F. Horton, 
(with end., for Dr. S. H. Sawyers,) Dr. W. Gutch— 
Kentucky. Dr. J. J. Burch, (with end.) — Maryland, 
Dr. J. Dwinnelle, Dr. A. S. Forwood, Dr. F. Zacha- 
rius — Neiv Jersey, Dr. G. Grant, Dr. J. T. Calhoun — 
New York, Dr. L. C. Hassell, (with end.,) Dr. Ira 
D. Hopkins, (with end.,) Dr. J. C. Dal ton, Dr. M. 
Stephenson, Dr. A. P. DeWees — Pennsylvania, Dr. 
J. L. Suesserott, (with end.,) Dr. S. M. King, Dr. 
Leisenring, (with end.,) Dr. G. R. McCoy, (with 
end.,) Dr. J. A. Reed, Dr. G. W. Smith, (with end.,) 
Dr. D. 0. Crouch, Dr. E E. Smith, (with end.,) Dr. 
J E. Groff, (with end.,) Dr. D. G. Schoner, (with 
end.,) Dr. J. L. Atlee, Jr., (with end.,) Dr. J. L. 
Cook, (with end.) — Tennessee, Dr. Wm. Spillman — 
Vermont, Dr. S. R. Day, (with end.) 

Office Payments. — Dr. P. R. Wagenseller, (Pa.,) 
Dr. C. W. Backhus, F. C. Eckleman, Dr. Burmeister, 
Dr. A. H. Senseny, (Pa.,) Dr. S. xM. Harry, (xAId.,) 
by Mr. Swaine ; Drs. Zorn, Keichline, Nordman, 
Hatfield, McQuillan, Hartshorne, Goodwillie, Haz- 
zard, Pepper, Smith, Summers, Brooks, Dickson, 
Clapp, Powers and Weightman. 



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Convulsions 

Congestion of Brain 

Disease of Brain 

Delirium Tremens 

Epilepsy 

Hydrocephalus 


Paralysis 

Tetanus 

Circulatary System,. 
Aneurism 


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Disease of Liver 

Gastritis 

Hepatitis 

Inflammation of Throat, 

Intussusception 

Inflam. of Bowels 


ftiarasmus 

Peritonitis 

Urinary Organs. 

Albuminuria 

Diabetes 

Disease of Kidneys, Blad- 
der, and Urethra 

Diseases of Uncertain 
Seat. 


Cancer 

Dropsy 

Debility 

Fever 

Scrofula 

Puerperal Diseases. 

Hemorrhage 

Convulsions 

Fever 

Diseased Womb 

External Causes. 

Accidents 

Poisoning 

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Stillborn 

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Black and colored 

United States 

I'oreien countries 


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Parentage. 

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Foreign 


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THE 



MEDICAL AND SURaiCAL REPORTER. 



"^^ NO. 20^'' } PHILADELPHIA, OCTOBER 20, 1860. { ^S^v'^al^ 



ORIGINAL DEPARTi^ENT. 

LECTURES. 

Lectures on the Crystalline Lens and its 
Diseases. 

No. 2. 

Delivered at the Howard Hospital, 

By Laurence Turnbull, M. D., 

Ophthalmic Surgeon to the Hospital. 

DIAGNOSIS OF CATARACT, CAUSES, AND PREPARATORY 
TREATMENT. 

In my last lecture, I entered upon the posi- 
tion, size, specific gravity, nature, injuries, and 
diseases of the crystalline lens, concluding my 
hour by referring to the diagnosis of cataract, 
a matter of the utmost importance to your fu- 
ture success, which I intend entering upon more 
fully at this time. I cannot do better for you 
than by relating briefly two cases. The first 
was a young man, who was sent me by a 
physician, and in the note which he brought 
with him, the case was described as one of 
amaurosis. This was the third physician who 
I had had him under charge, and, I am sorry 
to say, had looked at his eyes, but not in a 
proper manner. The pupil was perfect, the eye 
natural, but vision very defective ; no apparent 
opacity was at all visable to the unassisted eye, 
he had **musc£e volitantes" of a reddish color 
constantly floating before him ; he was incapa- 
ble of attending to his occupation, and was very 
much depressed in mind, owing to the unfavor- 
able prognosis before given him. 

Upon dilating the pupil with atropia, and 
examining the eye with a double convex lens 
,^y the light of a candle, all doubt at once was 
•emoved, by finding a beautiful cataract, still ( 
5 



imperfectly formed, which could be removed by 
an operation. To be absolutely certain, (which 
we ought always to be if possible,) I examined 
him catoptrically, according to the method of 
Purkinje, and as this is one of our most essen- 
tial aids in diagnosis, I will describe it. Hav- 
ing dilated the pupil of the suspected eye by 
means of the extract of belladonna, applying it 
in a soft state on a piece of muslin around the 
forehead of the patient, the night before, or the 
solution of atropia, dropped into the eye half 
an hour prior to the examination, and causing 
the patient to shut the eyes until the time has 
expired — the surgeon and the patient should 
be placed in a room, from which the daylight 
is entirely excluded ; the patient should be 
seated on a stool or chair lower than that of 
the examiner, so that the observer may look 
down into the eye ; a candle is to be employed 
which burns steadily, shaded by the hand of the 
examiner, that its light may not fall into his 
eyes. 

When a lighted candle is thus held before a 
healthy eye, at the distance of a few inches, 
three reflected images of it are seen, placed one 
behind the other. Of these, the anterior and 
posterior are erect, the middle one inverted. 
The anterior is the brightest and most distinct ; 
the posterior, the least so. The middle one is 
the smallest. The anterior is formed by the 
cornea ; the middle by the posterior surface of 
the capsule and the crystalline lens ; the pos- 
terior by its anterior surface. The cornea being 
a convex surface reflects an erect and diminished 
image, which moves in the same direction as 
the candle when this is carried laterally. The 
anterior crystalline capsule, being also convex, 
reflects a similar image, being, however, larger, 
but paler ; while the posterior crystalline cap- 
sule being a concave surface, the image reflected 
from it is inverted, moving in a direction oppo- 
site to that of the candle, and is the smallest of 
the three. It may be proper for me at this time 
to state the optical law which relates to this 
53 



54 



LECTUEES. 



Vol. V. No. 3. 



plienomenon, for the benefit of the more youth- 
ful part of my audience, namely, that instru- 
ments like the eye which operate on light by 
refraction are termed dioptric, and those M^hich 
operate on light by reflection are termed cato-p- 
tric. 

In cataract, the superficial erect image which 
is formed by the cornea suffers no change, but 
obliterates the inverted image, even at an early 
stage, and renders the deep erect one, very in- 
distinct. 

' In estimating the changes which occur in the 
appearances of the images reflected from the 
eye in its several diseased states, it is neces- 
sary, as Dr. Staberoh has remarked,^ to take 
into account two sources of these changes, viz : 
the state of the surfaces which form the images, 
and that of the media through which we see 
them.^' These two sources of error can be over- 
come at the present day by another most valu- 
able and all-important aid to our diagnosis of 
cataract, viz : the ophthalmoscope. Its import- 
ance in diagnosis will be illustrated by the 
second case. 

J. T., aged fifty-one, a man of wealth from 
one of our Southern cities, was brought to my 
ofiice for the purpose of consultation, by a phy- 
sician of this city. A distinguished and learned 
surgeon had pronounced his case as one of: cata- 
ract, and he had given him a solution of atro- 
pia to keep the pupil dilated. The subjective 
symptoms in his case had been in active opera- 
tion for six months, he, at that time, having 
tried his ej^es with close and constant writing 
by the gas for some time, causing his vision to 
become much obscured in the left eye, and great 
lachrymation and pain on exposure to light. 

The objective symptoms were those of chronic 
conjunctivitis with pterygium on the nasal 
side, several large muscular vessels passing 
into it, a few straight vessels running from the 
sclerotic to the cornea. On examination of the 
cornea, it was seen that there had been a cer_ 
tain amount of inflammation, causing the gray 
line around its circumference. 

On examining by oblique illumination, by 
means of the double convex lens, nothing was 
found abnormal in the cornea, anterior cham- 
ber, capsule of the crystalline, or the lens itself. 
The catoptric test was also resorted to, and all 
the images were found perfect. The confirma- 
tion of the above was to be found in the use of 
the ophthalmoscope, which is to be employed, 

* Medical Gazette, Vol. XXL, p. 107, London, 1838. 



with a faint light, when we examine cases of 
cataract; for if the fall flame of a gas burner is 
employed, the intense light renders very faint 
strise invisible, and dense opacities appear as 
radiating black lines. But, to return to our case, 
a slightly diffused haze was found apparently 
in the vitreous humor, the entrance of the 
optic nerve was normal, and the retina pre- 
sented a slightly-congested appearance, owing, 
perhaps, to the result of the long continued ex- 
amination. Thus, the opthalmoscope at once 
sets at rest the cause of the opacity in the eye, 
by showing where the disease was situated. 

We will now continue the subject of diag- 
nosis, having described the means of arriving 
at such an important result by its application to 
two cases. 

Subjective or physiological signs, abbreviated 
from Mackenzie : 

1st. Impaired vision in cataract generally in- 
creases slowly for a time, and is compared to a 
mist, fog, or gauze, gradually becoming thicker, 
until everything seems concealed by it, or en- 
veloped in it. 

2d. The sensation of a mist or cloud is per- 
ceived most when the patient looks straight 
forward, and he always sees considerably better 
when he looks sideways. This is not the case 
usually in persons over the age of forty years, 
but applies to cases previous to that age. 

3d. In bright light which causes the pupil to 
contract, fewer rays of light enter the eye, and 
hence vision is obscured ; while at twilight, or, 
with the patient turned from the light, vision is 
improved. 

4th. On looking at the flame of a candle, or 
gas burner, the light seems expanded into a 
larger globe of weaker light. 

5th. In incipient cataract, the patient some- 
times sees with one eye objects multiplied. 

6th. If the cataract is central, a solution of 
atropia assists vision, but if the opacity is in 
the circumference, he is not benefitted. 

Objective or anatomical signs : 

1st. The cataractous patient approaches you 
with his eyes shaded with his hand, and his 
head turned downward, and to one side. 

2d. The pupil contracts and expands as ex- 
tensively, and as vividly as in the healthy eye. 

3d. The cloudiness in incipient cataract is 
whitish, or of the bluish tint of milk and water. 

In a letter to the President of the Eoyal Aca- 
demy of Medicine of Paris, in 1842, Malgaigne 



October 20, 1860 



LECTURES. 



55 



asserted tlie positive fact that in tlie cataract in 
adults and aged persons, the opacity always 
commenced in the circumference, gradually 
spreading toward the centre of the lens. This 
fact has been confirmed by observations of 
Stellwag, made with the additional advantages 
which the microscope affords. This highly 
important application of these observations 
made by an original observer, Mr. Dixon, 
was published in the Lancet, in ISoC*. An 
elderly patient presents himself, complaining 
of some slight mistiness and indistinctness of 
sight. The iris may be active ; the area of 
the pupil of natural blackness. Cataract will 
not suggest itself to the surgeon, if he be pre- 
judiced by believing that it almost always com- 
mences in the centre of the lens ; and he will, 
probably, regard the dimness of sight as alto- 
gether of nervous origin. But let him fully 
dilate the pupil with atropia, and then throw 
light upon each part of the lens in succession, 
by means of a convex glass of about one inch 
focus ; he will, perhaps, find the whole pos- 
terior face of the lens covered with faintly yel- 
low, opaque lines, radiating inward from the 
margin, and along the latter part, grouped to- 
gether here and there into patches ; or these 
marginal patches may exist at one or two 
points only, the hinder part of the lens being, 
to a considerable extent, clear. This would de- 
note a still earlier stage of the disease. Or, 
again, in addition to opaque patches at the 
edge of the lens, a few stri^ may be traced 
along the front surface, stopping short of the 
border of the natural pupil. The anterior posi- 
tion of these stri^ can, of course, be at once 
recognized by a practised observer ; but it may 
aid the less experienced to be told that the 
opaque streaks of a cataractous lens are in 
themselves white. Those on the anterior sur- 
face, therefore, being viewed through colorless 
media — the cornea and aqueous humor — retain 
their white appearance ; while those behind 
acquire a yellow cast, from being seen through 
the still transparent part of the lens."^' 

According to Dr. Mackenzie and other good 

' authorities, the following circumstances should 
be attended to in cases of cataract, before per- 
forming any operation : 

1, The" opacity; its color, extent, form, and 
seat. Whiteness denotes either a dissolved lens 

' or a capsular cataract ; grayness, a lenticular 
cataract ; amber, or dark grayness, that the 

* See Buete, pi. xxxi, Fig. 3. 



lens is hard ; light grayness, that it is soft. If 
the whole extent of the pupil is uniformly 
opaque, the cataract is lenticular ; if the opacity 
is streaked or speckled, it is more likely to be 
capsular. Baer states that in anterior capsular 
cataract the stripes are of a bright-gray, chalky- 
white, or mother-of-pearl appearance. Capsu- 
lar cataracts, as a class, are tough. 

When the cataract is complicated with glau- 
coma, it has almost always a greenish or sea- 
green color, is exceedingly large, so as to pro- 
ject itself from the pupil toward the cornea, 
with flashes of light and constant headaches. 
These latter cases must not be operated upon, 
as the patient never regains useful vision, and 
is very liable to arthritic inflammation. A 
dingy color of the sclerotica indicates an unfa- 
vorable eye for operation. A stony hardness 
of the eye is also unfavorable. 

Causes of Cataract. — Advanced age ; unusual, 
sudden, and strong irritation of light on new- 
born or delicate children ; working over strong 
fires ; too free use of malt liquors or spirits ; 
wounds of the eye and of the lens. I am con- 
vinced, with Baer and "Walther, that the greater 
number of cataracts are the result of inflamma- 
tion of the lens and its capsule. Cataract is 
often hereditary or congenital. In a family 
that I attended, three persons were affected, two 
brothers and a sister. In frogs, it has been pro- 
duced by the injection under the skin of various 
substances, in solution, as sugar, certain salts, &c. 
It has been produced by pressure ; and we know 
that after death pressure of the eye causes opa- 
city of the lens. The increased imbibition of 
the dense fluid in the capsule of the lens press- 
ing upon it may produce this result. 

Disease of the heart is often complicated with 
cataract. It is apt to be witnessed in the scrofu- 
lous, syphilitic, gouty, and rheumatic diatheses; 
also in cases of diabetes mellitus. 

Medical Treatment. — A cure of perfectly formed 
cataract by medicines, has been hitherto deemed 
impossible. Commencing cataracts, however, 
are supposed to have been cured, both in for- 
mer and even in our own times, by mercurials, 
antimonials, digitalis, belladonna, and Pulsa- 
tilla. The most recent article, which received 
considerable attention from the Surgical Society 
of Paris, was Gondret's ammoniacal ointment ; 
but it was shown, during the discussion, that 
those cases which were benefited were not cases 
of incipient cataract, but instances of an early 
stage of amaurosis. The operation still remains 
the only tolerably certain means for the remo- 



56 



LECTUEES. 



Vol. Y. No. 3. 



val of tliis affection, if the case is properly 
selected and a correct diagnosis made. 

Treatment Preparatory to an Operation. — If the 
patient is in sound health, no preparatory 
treatment is required, but if otherwise, we must 
endeavor to bring him into that condition, by 
every means in our power, and not operate until 
this object has been accomplished. The state 
of the digestive organs should be carefully stu- 
died, as nothing, according to Dr. Jacob, seems 
to require more attention than the state of the 
tongue, as indicative of the state of the stomach 
and bowels. If it be white, or coated with dis- 
colored adhesive mucus, the functions of assi- 
milation and nutrition are probably imperfectly 
performed, and a resulting tendency to destruc- 
tive inflammation from local injury is engen- 
dered. 

This is seen every day exemplified in acci- 
dental injuries of the cornea in stone cutting, 
chipping, and turning metals. If the patient 
has a clean tongue, and is otherwise free from 
disease, little inflammation, and still less of a 
destructive form follows the injury: but if the 
tongue be coated, with a thick yellow adhesive 
layer, ulceration and formation of purulent 
matter often ensue. 

In preparing a patient for operation for cata- 
ract, this will therefore demand the first care 
of the surgeon, especially if he finds, as he 
often does, a deposition of lithates or other 
salts in the urine. He will also make inquiry 
as to the state of the discharges from the bowels, 
as to their color, consistence, and proportion of 
undigested materials, and also as to the fre- 
quency of discharge, not looking upon what is 
called costiveness as evidence of deranged di- 
gestion, but rather the reverse, undigested food 
seldom remaining so long quiet in the alimen- 
tary canal as the insoluble remains of tho- 
roughly digested aliment mixed with the excre- 
mentitious part of the bile. This inquiry is 
not, however, so easily made as those who are 
satisfied with loose statements, suppose, and 
many think it unnecessary ; but Dr. Jacob is 
fully convinced that attention to this matter is 
necessary for the success of the operation. Dr. 
Jacob, in the Dublin City Hospital, where I 
saw him operate in the summer of 1859, relies 
upon a moderate purgative pill, with blue mass 
or calomel at night, followed by some aromatic 
hitter infusion, containing a little alkaline salt, 
in the morning and middle of the day ; at the 
same time, regulating the diet by restricting the 
bauntity and quality of the food, as well as the 



periods at which it should be taken. It is 
usual, in preparing for this and other opera- 
tions, to make great alterations in diet, substi- 
tuting liquid for solid, and vegetable for animal 
aliments. This, however, must be done with 
caution, leading, as it inevitably does, to dis- 
turbance of the digestive functions and inter- 
ruption of the assimilating and nutritious pro- 
cesses, if suddenly or exclusively adopted. 
Without digestible nutritious food, good chyle 
and blood cannot be produced, and without 
good blood, local injuries are liable to result 
in destructive inflammation. Even in the 
case of old persons, habitually indulging in a 
glass of wine or other alcoholic stimulants, Dr. 
Jacob considers the suspension of that supply 
of temporary aid to the nervous system, should 
not be suddenly adopted; in fact, the substitu- 
tion of "low living," and what are called 
" slops," for generous diet, should be gradually 
and sparingly practiced, if at all. In his own 
practice, he resorts to it as little as possible, 
and from a long experience feels inclined to re- 
sort to it less and less. 

In particular cases, the surgeon may be 
called on to prepare his patient by special 
directions of remedies to specific derangements 
of health. Persons of languid circulation and 
feeble frame must be invigorated by generous 
diet and tonic medicines, while those who are 
plethoric must be restricted in certain articles 
of diet, so as to bring the system into a per- 
fectly healthy condition. Scrofulous, gouty, or 
rheumatic constitutions must, if possible, be 
corrected ; but as this is not easily accomplished, 
it is always proper to inform the patient or 
friends that such cases are always liable to in- 
flammation, and that recovery of useful vision 
is seldom obtained even after the most success- 
ful operation. 

In my next lecture, I will take up the con- 
sideration of the operations for cataract. 

An Indian Medical Journal. — By the last mail 
from India we have received a prospectus of a 
new Indian Medical Journal, entitled the Ak- 
bare Tubabut, or Medical Gazette. A specimen 
page, lithographed in Oordoo, is before us, and 
we are informed that the Tubabut is intended as 
"a medium of communication between native 
Doctors in Government employ and native Ha- 
kims, for the improvement of Medical and Sur- 
gical knowledge, and the greater alleviation of 
the many diseases to which the millions of in- 
habitants of this country are subject." We sin- 
cerely hope that it may succeed in the accom- 
plishment of such desirable objects. — Medical 
Times. 



October 20, 1860. 



COMMUNICATIONS. 



57 



COMMUOTCATIONS. 

Concussion of the Brain and Injury of the 
Pneumogastric Nerve. 

By B. Woodward, M. D., 

Galesburg, 111. 

Claude Bernard took high ground when he 
enunciated the doctrine, " that most, if not all, 
forms of disease, depend on the irritation of the 
nerves.^' 

Cases occur in the practice of every physi- 
cian which, if closely observed, go to prove 
the general correctness of the assertion of the 
great physiologist. If this is the true doctrine 
of disease, it must, when well understood, have 
great influence in establishing a rational mode 
of treatment. 

It is this view which leads me to give a his- 
tory of a case in my own practice, as every well- 
established fact is of value in determining the 
correctness of a theory. 

Ellen , servant in a family in this city, 

on the evening of the 30th of July last, fell 
from the top of a high flight of stairs into the 
hall below. In so doing, she struck her neck 
across the edge of the lower step. She was im- 
mediately picked up, and, as she did not breathe, 
was thought to be dead. 

I saw her within a very few minutes after the 
accident. She was pulseless at the wrist ; face, 
lips, and conjunctiva blanched ; eyes and 
mouth open. Pressing my hand over her heart, 
I could discover a very slight and indistinct flut- 
ter, but no regular beat. I took the pillows 
from under her head, closed her mouth firmly, 
and taking her nose in my mouth, inflated the 
lungs fully, pressing on the thorax after every 
insufiiation to expel the air. Keeping my hand 
on her heart, I found in about two minutes that 
the beat became distinct, and in about fifteen 
minutes she gasped slightly three or four times. 
It was half an hour before the pulse in the 
radial was perceptible, and two hours before 
she breathed without the artificial inflation. 
All this time the neck, which showed a dark 
red bruise all across the left side, from the edge 
of the stair, and the thorax, were well rubbed 
with stimulating liquids, and sinapisms were 
kept on the legs and arms. For twenty-four 
hours there was no perceptible motion of the 
diaphragm in breathing, neither was she sensi- 
ble for a moment during this time. As soon as 
she could be made to swallow, hot, strong cof- 



fee and brandy were poured down her throat. 
Though breathing had been in a measure 
established within two hours from the time of 
the accident, it would be suspended at times for 
several minutes, and could only be re-estab- 
lished by inflating the lungs as at first. For 
twenty-four hours there was complete arrest of 
the urinary secretion, neither was she in the 
least conscious for the same length of time. 
There was complete aphonia for three days, 
and for two weeks partial, with dyspnoea and 
cough. It was four days before there was the 
least desire for food, though she took it in small 
quantities. She has since passed from my ob- 
servation, having gone to her friends in another 
county ; though I heard from her the last of 
August that she was very weak and had a bad 
cough. Previous to her fall she had been a re- 
markably strong, healthy girl. There was evi- 
dently concussion of the brain, manifested by 
the paleness of the countenance, and the insen- 
sibility. There was injury of the medulla 
oblongata, as shown by the arrest of the action, 
of the kidneys ; and injury of the pneumogas- 
tric nerve, paralysing the action of the heart, 
lungs, and diaphragm, and, to some extent, the 
stomach. The point of great interest to me is : 
the production of the cough, which was dry, 
hard and spasmodic. By the most careful 
auscultation and percussion of the chest, I was 
not able to find anything which should have pro- 
duced it. The shock given to the nerves going 
to the larynx will account for the aphonia, but 
in what way did the nervous paralysis or irri- 
tation produce the cough ? This is one of the 
points insisted on by Bernard ; but the question 
with me is not so much the fact itself, as the 
mode or species of irritation, and whether it 
was expended on the lungs or diaphragm, or 
both ? 

There are points of interest in the case both 
physiological and pathological, which suggest 
themselves to every thinking mind ; and per- 
haps you, or some of your readers, may think it 
worth while to throw some light upon them. 
o 

Spontaneous Combustion. — A disastrous fire re- 
cently occurred in Long Acre, London, caused 
by spontaneous combustion of lampblack. It 
is said that but a few drops of linseed oil in a 
cask of lampblack will cause combustion. If 
this is so, it is a fact important to be known 
that it may be guarded against. Merchants 
and others, who ship tarpaulins prepared with 
oil and lampblack, should be certain that they 
are thoroughly dried and seasoned before 
packing. 



58 



COMMUNICATIONS— HOSPITAL PEACTICE. 



Vol. Y. No. 3. 



Dislocation of the Femur on the Dorsum Ilii 
of Right Side— Reduction— Fracture of the 
Upper Third of Tibia and Fibula— Lace- 
ration of the Left Foot and Popliteal Space 
—Death. 

By W. B. Erdman, M. D., 

Of Millerstown, Pa. 

J. Y., aged 50, while digging in an ore bed, 
was entirely buried by the bank caving in upon 
him. He was undermining, and the bank struck 
his left leg, and threw him down, burying him 
completely. 

He was extremely prostrate from the shock 
and injuries received ; there was hardly any 
pulse to be felt at the wrist. Although the pa- 
tient lost some blood, the hemorrhage was so 
slight that there was no necessity of applying a 
tourniquet to the lacerated limb. 

As the patient was in a very prostrate condition? 
the muscles were relaxed, and the dislocation of 
the femur was easily reduced by the admirable 
mode of reducing such luxations suggested by 
Dr. Wm. Eeid, of Eochester, New York. It is 
certainly a great improvement on the mode 
of reducing dislocations, with pulleys, sheets, 
straps, and hooks, especially in a case like this, 
where the dislocation is accompanied with a 
fracture of the bones of the leg. 

The following is Eeid's plan, as described in 
the " Treatise on the Practice of Surgery" by 
Dr. H. H. Smith, (Prof of Surgery in the Uni- 
versity of Pennsylvania.) 

" Eeid's plan of Eeducing a Luxation of the 
Femur upward and backward on the Dorsum 
of the Ilium, solely by Manipulation." — " Place 
the patient on his back, on a low, firm table, 
or, what is better, upon a quilt, folded and laid 
on the ground. Let the operator stand or kneel 
on the injured side, and seize the ankle with 
one hand and the knee with the other. Then 
flex the leg on the thigh ; next strongly abduct it, 
carrying it over the sound one, and at the same 
time upward over the pelvis by a kind of semi- 
circular sweep as high as the umbilicus. Then 
abduct the knee gently, turn the toes outward, 
the heel inward, and the foot across the oppo- 
site and sound limb, making gentle oscillations of 
the thigh, when the head of the bone will slip 
into the socket with a slight jerk, or an audible 
snap, and the whole limb will slide easily down 
into its natural position beside the other." 

Stimulants were freely administered to the 
patient above alluded to, but no reaction took 
place, and he died in about five hours after the 



accident occurred. 'All the articulations of the 
bones of the left foot were lacerated and torn 
asunder; the blood vessels and nerves in the 
popliteal region of the same limb were all ex- 
posed, but without any of them receiving any 
injury. 



Iltetratinns flf Jnspitul fmrtirL 

PENNSYLVANIA HOSPITAL. 

Service of Dr. J. Forsyth Meigs. 
CHRONIC PLEURISY ; DILATATION OF THE PULMO- 
NARY ARTERY ; CARIES OF THE SPINE. 

The patient is a young woman, not married, 
22 years of age, born in Ireland. She entered 
the hospital on the 8th of September ; she states. 
that she was in good health until two years 
ago, when she ''took a cold," and her health 
failed ; she had pain in the back, but none in 
the side, and no cough. 

Her present illness dates back two or three 
weeks before her admission into the hospital. 
When first seen by Dr. Meigs, she was suffering 
from severe pain in the dorsal region, shoot- 
ing downward and forward. 

On Inspection, the left side of her chest is 
found contracted, flattened, sunken in, and its 
anterio-posterior diameter diminished, as usually 
found in old cases of pleurisy. 

Percussion over the right side yields full reso- 
nance ; over the left side the percussion-sound, 
however, is dull, flat, almost toneless. 

Auscultation. In the right lung, there is very 
good, healthy vesicular respiration, no rhonchi, 
no signs of bronchitis ; expiration, however, is 
somewhat prolonged. On the left side, the re- 
spiration is harsh, crude ; the vesicular mur- 
mur imperfect, and marked by a coarse friction 
sound. 

All the physical signs thus indicate contrac- 
tion of the lung, in consequence of chronic 
pleurisy, which formed adhesions binding the 
lung down, and there can hardly be a doubt 
that her sickness two years ago was an attack 
of pleurisy. 

There is, however, another point of great in- 
terest in her case. On examining the heart, the 
apex beat is found in its normal position a lit- 
tle distance below the nipple ; but a well-marked 
pulsatory impulse is seen between the second 
intercostal space to the left, and, on ausculta- 
tion, the first sound of the heart is found rough- 
ened and accompanied by a peculiar squashy 
sound. This pulsation and roughened cardiac 
sound are caused by active dilatation, j^robably, 
of the pulmonary artery, in consequence of the 
contracted condition of the left lung. If we 
look at the anatomical relation of the parts, it 
is easy to see why the pulsation becomes appa- 
rent externally. The lung (which, in its natu- 



October 20, 1860. 



HOSPITAL PEACTICE. 



59 



ral condition, covers the heart) is in this case 
retracted, and thus the heart is brought nearly 
in contact with the thoracic parietes. 

Anotlier very curious phenomenon in this 
case is a bronchial rhonchus, heard on putting the 
ear upon the anterior upper part of the chest, 
which rhonchus is synchronous ivith the cardiac 
rythm, instead of accompanying the respiratory 
movements. This is in consequence of the im- 
pulse of the heart being communicated to some 
of the larger bronchi. 

Finally, this patient presents a slight anterio- 
posterior curvature of the spine, which was dis- 
covered on examining her as to the cause of the 
pain, to which she is subject. There is caries 
of one or more of the dorsal vertebra, which, 
together with the intervertebral substance, have 
been partially absorbed. 

This case illustrates forcibly how important 
it is in cases of spinal disease, and in fact in all 
diseases, to make a close examination, and to 
inspect, feel, and see. 

Pain is often, for a long time, the only sub- 
jective symptom of caries of the spine ; and 
what an error to call it rheumatism or neural- 
gia, when inspection may at once lead to a de- 
tection of the true nature of the difficulty ! 

The treatment in this case should be to build 
the patient up by proper diet and a tonic course. 



EPISCOPAL HOSPITAL. 

Service of Dr. R. P. Thomas. 

[Reported by Dr. B. E. Fryer, Resident Physician.] 

THREE CASES OF SEVERE INJURY TO THE HEAD, 

WITH RESULTS. 

Case 1. Michael O'D., an Irish seaman, while 
returning to his vessel after a debauch, fell a 
distance of thirty feet through the tressel work 
on the Eichmond coal wharves. He was dis- 
covered by some sailors and brought to the 
hospital about six hours after the injury. When 
we saw him, he was comatose, blood oozing 
from both ears ; breathing, stertorous ; pulse, 
50 and full, with a peculiar thrill ; skin cool ; 
pupil of left eye dilated ; right contracted ; pa- 
ralysis of facial muscles of right side ; he was 
restless and could not be roused. Upon exami- 
nation, we found severe contusion of the right 
side of the head and face, with a fracture of the 
lower jaw at the angle ; but no fracture of the 
skull was discoverable, which the symptoms 
led us to believe existed. 

He was ordered liq. morph. sulph. f^ j, with 
ext. conii gr, iij, every four hours, to quiet the 
restlessness, and the head to be shaved, and ice 
constantly applied to it. The next day he was 
quiet — blood still oozing from ears ; other symp- 
toms the same. Ordered blisters to calves ot 
legs, and an enema. On the fourth day, the 
oozing from the ears had ceased, and he began 
to show signs of returning consciousness ; the 
pulse and respiration were nearly natural. On 
the seventh day, the following note was taken : — 



" He is unable to close his right eye, and unable 
to open the left. There is paralysis, both of 
motion and sensation of the nerves supplying 
the right side of face, and he cannot draw the 
left eye-ball either inward or upward. On 
examination with the aural speculum, both 
membranag tympani are found lacerated." 

At the end of four weeks, he was allowed to 
sit up, when we discovered that he was myopic 
in the right eye, and presbyopic in the left. It 
is now three months since the injury, and he is 
gradually recovering from the paralysis ; his 
mental faculties are as good as ever. 

That there was compression of the brain in 
this case, is easily seen from the symptoms ; 
but whether there was or was not a fracture at 
the base of the skull, is difficult to say, though 
we strongly suspect there was. The compres- 
sion, however, must have been limited in ex- 
tent, as we had only paralysis of the oculo- 
motor and pathetic nerves of the left side, and 
of the facial nerve of the left. 

Case 2. James Malone, Irish, aged 26, was 
admitted into the house with a severe injury to 
the head and body, caused by a loaded coal 
cart passing over him in an oblique direction. 
There was considerable hemorrhage from the 
left ear ; the pupil of the right eye was dilated, 
and the lid shortly after dropped ; the skin was 
cool ; pulse slow and full ; he vomited copiously ; 
talked rationally. We could trace the line of 
contusion caused by the wheel, which passed 
from the nape of the neck up over the ear ; but 
could find no fracture of the skull. The left 
membrana tympani was lacerated. 

The day following his admission, the oozing 
from the ear had ceased ; there was slight par- 
alysis of the facial muscles of the right side; he 
complained of severe pain in the head ; vomited 
a large quantity of dark blood. Ordered blister 
to calves of legs, and hydr. protiodid., gr. \, 
every four hours. By the fifth day, the paraly- 
sis had all passed away ; but he still comj)lained 
of severe pain in the head. At the end of two 
weeks, this man was allowed to sit up, and in 
four was discharged cured. 

It is wonderful that such a weight as a loaded 
coal cart passing over the head did not produce 
a more serious injury. 

In both of these cases, we had symptoms of 
fracture of the base of the skull, and in both a 
recovery. 

Case 3. Hugh L., English, aged 40, was ad- 
mitted into the hospital September 17, 1860, for 
an injury caused by the bursting of a large 
grindstone, at which he was working — one-half 
of which, flying in the air, struck him in the 
face in its ascent. The accident occurred about 
three hours before admittance ; he was still suf- 
fering from shock ; had lost about half a pint 
of blood; pulse 80 — quick and easily com- 



60 



HOSPITAL PEACTICE. 



Vol. V. No. 3. 



pressed ; skin cool ; pupils nearly natural ; was 
quite restless ; answered questions imperfectly. 
Towards evening, pupil of left eye became some- 
what dilated ; respiration sterterous ; pulse 100. 

The face was swollen to an enormous size. 
All but one of the upper teeth were knocked 
out; the superior maxillary bones were frac- 
tured in two places ; the nasal bones and the 
nasal processes of superior maxillary were all 
fractured. There was considerable hemorrhage 
from both nose and mouth. The bones were 
moulded in position by Dr. Thomas, and a Bar- 
ton^s bandage applied, so as to keep, by the 
support of the lower jaw, the upper in position. 
He was ordered an ounce of beef tea and wine 
whey every two hours, with sufficient morphia 
to quiet him, and cold water to be kept con- 
stantly to head and face. 

On the third day, erysipelas set in on left side, 
which was gradually spread over the whole 
face. There was now a profuse discharge of 
pus from the nose. Ordered twenty-five drops 
tinct. of chloride of iron and one grain quinia 
every four hours, with lead-water and laudanum 
to face. 

On the fourth day, he was delirious, so much 
so that he had to be secured to be kept in bed. 
Ordered an enema. 

At the expiration of a week, the erysipelas 
began to abate, and the man became more ra- 
tional, and has been steadily improving ever 
since. The bones have all united quite firmly, 
and there is Very little deformity, considering 
the severity of the injury. He is weak yet, but 
will be sufficiently well to be discharged in 
about ten or twelve days. 



UNIVERSITY OF PENNSYLVANIA. 

MEDICAL DEPARTMENT. 

(Service of Dr. Pepper.) 

EFFECTS OF TOBACCO. 

This patient is a common day laborer, be- 
tween 50 and 60 years of age. He complains 
of having been out of health for two or three 
years, having lost flesh, his appetite declining, 
being troubled with sour stomach. 

On close examination no organic disease 
could be detected. There is no enlargement of 
the liver, no pain about the chest, no cancerous 
disease of the stomach or pylorus, no tubercles 
in his lungs. 

The patient states that for the last twenty- 
five years he has been chewing about one- 
quarter of a pound of tobacco per week, while 
he has also been using the weed freely in the 
shape of smoking. He had been told some 
months ago that smoking was hurtful to him, 
and having since stopped it, his health has im- 
proved, and he is gaining strength and flesh. 

Prof. Pepper remarked, that tobacco was a 
very frequent source, not only of functional 



disturbances but of organic disease. Cases had 
fallen under his observation in which the efiects 
of the abuse of tobacco closely resembled deli- 
rium tremens ; we must, however, be careful 
in the sudden withdrawal of the article, which 
the system, so long accustomed to its use, can 
often not bear. 

Treatment. — Let him continue to abstain from 
smoking, and gradually stop chewing tobacco, 
substituting in its place chamomile flowers. 



JEFFERSON MEDICAL COLLEGE. 

Service ol Prof. Gross. 
[Reported by Mr. N. G. Blalock.] 
INJURY OF THE HIP JOINT. 

This patient was a little boy, six years of age, 
who three months ago had received an injury, 
by falling a distance of three or four feet from 
a chair, and injuring his left hip. 

When standing up, the left ilium was -raised, 
so as to render the leg of the same side appa- 
rently shortened ; at the same time there was 
an incurvation of the body from left to right. 

It was at first supposed to be a case of anchy- 
losis; but the patient being put under the influ- 
ence of chloroform, in order to make a thorough 
examination, it was found that there was only 
partial rigidity from inflammation set up in the 
joint, in consequence of the fall ; that plastic 
material had been thrown out, causing evidently 
thickening of the synovial membrane and 
roughening of the articular surfaces. 

The incurvation of the body in this case is 
caused not by any actual displacement of the 
vertebrae or hip, but is the natural, instinctive 
efibrt of the child to relieve the pain. By raising 
the hip and bending the body toward the sound 
side, the acetabulum is separated as far as pos- 
sible from the head of the femur, thus prevent- 
ing friction and pressure of the inflamed parts. 
It is the natural eflPort of nature to secure rest. 

Treatment. — The main object should be to 
cause absorption of the plastic matter effused, 
and to reduce the thickened membrane to its 
normal condition. The hot and cold douches, 
used in immediate succession twice a day, and 
followed by friction with soap liniment, to which 
a little veratria may be added, will be of ser- 
vice. There may be considerable difficulty in 
removing the incurvation of the body. The 
passive motion should be repeated every twen- 
ty-four hours. 

CANCER OF THE BREAST. 

A, C, a colored girl, aged 22, unmarried, has 
been suff"ering for two years from a tumor in her 
right breast. It occurred first in the form of a 
small lump, the size of a hazel-nut, movable, 
painless. It remained stationary until eight- 
een months ago, when it began to grow very 
fast, until it assumed the size of a fist, and 
recently it has become painful, the pain, as she 



October 20, 1860. 



HOSPITAL PEACTICE. 



61 



describes it, being of a stinging character. 
The nipple is not retracted. 

Her general health is good; functions regular. 
There was no swelling of the glands of the ax- 
illa or neck. 

Dr. Grross remarked that the tumor had more 

of the external features of encephaloid than of 

scirrhous. The case was one favorable for an 

operation, but as the disease was sure to return, 

1 the prognosis must hence be guarded. 

The entire gland was removed by making a 
vertical eliptical section of the skin, and dissec- 
ting out the mass. The wound was closed by 
the metallic suture. 



STONE IN THE BLADDER — LITHOTOMY. 

A boy, four years and a half old, was brought 
in the clinic, with the following history : 

He has been suffering for ten months with 
pain in the bladder, and irritation in the glans 
penis, with a con tinned desire for micturition, 
having to pass his water fifteen to twenty times 
in twenty-four hours. His general health is 
good. On sounding the bladder, the stone 
was readily detected. 

Before attempting an operation, the patient's 
system should be thoroughly prepared, by ad- 
ministering mild cathartics, light diet, impos- 
ing rest, and on the night previous to the 
operation, the bowels should be thoroughly 
cleansed by a sufficient dose of castor oil. 

In performing the operation of lithotomy, we 
shall divide the integument, areolar tissue, super- 
ficial fascia, transverse perineal muscle, mem- 
branous portion of the urethra, deep fascia, the 
left lobe of the prostate gland and theneck of the 
bladder. The patient being put under the in- 
fluence of an anaesthetic, a grooved staff should 
be introduced into the urethra and bladder, and 
be held by an assistant, who should stand on the 
left side of the patient. In an adult, commence 
the incision about an inch above the anus, and 
carry it downward and outward, one and a half 
inches below the anus. In a patient of this 
age, of course the incision is not made so long. 
The internal opening should be as small as 
possible, compatible with the easy extraction of 
the stone. 

The operation was then performed by Dr. 
Grross in the manner described. The stone was 
about one inch in its long, and three-quarters 
of an inch in its transverse diameter, with a 
somewhat roughened surface. The parts are 
not sown up, as in other wounds, but allowed 
to unite by the granulating process. The 
general after-treatment should be antiphlogis- 
tic. 



VARICOSE ULCER. 

Mr. M., aged 30, of good general health, has 
an ulcer of eighteen years standing. It is situ- 



ated on the inside of his left leg, extending 
from the ankle joint up the limb, a distance 
of about three and a half inches. The internal 
saphenous vein is enormously enlarged, and the 
coats very much thickened, containing in some 
portions stones or phleholites of considerable size. 
All attempts have hitherto failed to heal this 
ulcer, and always will until this varicose con- 
dition of the veins be removed. I shall there- 
fore endeavor to relieve them by performing 
subcutaneous ligation in three or four places. 
This I shall do by passing a stout pin through 
and out on the opposite side. A strong silk 
the integument below the vein, ligature is 
then passed around both ends of the needle, 
and firmly tied, so as to enclose firmly the 
vein. We shall confine the man to his bed, 
and treat him antiphlogistically, giving him 
immediately an anodyne. After the veins 
are relieved of their varicose condition, and 
the natural circulation is established, the 
ulcer can be healed. We should always be 
very cautious in performing an operation on 
veins, from the fact that they are subject to 
inflammation, much more so than arteries. 
This man's general health is good — habits 
formerly intemperate. The result of the case 
will be reported hereafter. 



tlm\ ^^thim. 



PHILADELPHIA COUNTY MEDICAL 
SOCIETY. 

(Reported by Wm. B. Atkinson, M. D., Recording Secretary.) 

Wednesday Evening, October 10th. 
- Dr. Isaac Eemington, President. 

Subject for Discussion : Opium as a Therapeutic 
Agent. 

Dr. Gt. Hamilton opened the discussion by 
reading the following paper : 

The subject for discussion this evening (in- 
troductory to which I have been appointed to 
make some remarks) is " Opium, as a thera- 
peutic agent." Opium, or at least a substance 
closely resembling it in its effects on the human 
system, has been known and employed in me- 
dicine from the time of Hippocrates, or perhaps 
still earlier. And it is a somewhat singular 
and highly significant fact, that, during the 
lapse of so many ages, it has, with exceptional 
periods, continued to maintain the character of 
one of the most valuable medicines known to 
the Healing Art. We shall not perhaps err 
much in saying, that, at the present moment, 
its reputation as a curative agent is higher, in 
the estimation of our profession, than at any 
former period of its history. I repeat, as a 



62 



MEDICAL SOCIETIES. 



Vol. V. No. 3. 



curative agent. For, wkilst we are bound to 
admit that the sagacity of a Sydenham and a 
Pringle had long ago discovered in opium, 
qualities not merely palliative, but eminently 
remedial in their character, it seems to have 
been reserved to the times of a more enlight- 
ened physiological and pathological science to 
appreciate the real importance of this agent, 
and to define, measurably at least, the extent 
and applicability of its powers in the allevia- 
tion of suffering, or the prevention and cure of 
disease. 

In regard to the action of this medicinal 
agent upon the system, and the various effects 
it is capable of producing, either in the normal 
or abnormal condition, much diversity and even 
contrariety of sentiment has always existed. 
ISJ'or is this to be wondered at. For when it is 
considered that the primary operation of opium 
is nearly always, perhaps exclusively, upon the 
nervous system, the difficulty is easily under- 
stood. Even in our own time (notwithstand- 
ing the arduous and incessant labors of the 
physiologist and pathologist, aided as they are, 
too, by a more advanced physical, chemical and 
microscopical science,) the same difficulties to 
a great degree exist, and must continue to exist, 
so long as the normal functions of the nervous 
system are not more fully comprehended, and, 
above all, so long as the correlative movements 
of the three great divisions of this system are 
so imperfectly defined and understood. 

The most generally-received opinion, how- 
ever, at the present time, is, that opium, (and 
hy this term I mean the drug or any of its legitimate 
preparations,) in a moderate or even large dose, 
is stimulant in its primary action, especially to 
the brain, and sedative in its secondary eff'ects. 
The secondary action may be the result merely 
of the previous stimulation, or is possibly the 
more direct effect of some ulterior action, inhe- 
rent to the drug. The former is the more pro- 
bable, inasmuch as the primary stimulation 
and the secondary depression are generally in 
mutual correspondence. When opium is given 
in an excessive dose, it exercises a directly nar- 
cotic influence on the entire nervous system, or 
if any excitement precedes, it is so short as 
scarcely to be noticed. Of the different portions 
of the nervous system, the cerebrum, as before 
intimated, is that on which opium seems to 
act with greatest energy ; and the anterior part, 
where the more prominent of the intellectual 
and moral faculties are supposed to reside, is 
thought to be more particularly susceptible to 
its influence, and hence, as some suppose, the 
reason of the psychological phenomena and the 
impairment of the sense of smell and vision 
sometimes observed. 

Be this as it may, conclusive evidence of the 
stimulant action of opium upon the cerebrum 
is afforded in the daily use of this article by so 
large a proportion of the inhabitants of the 



East, and more especially by the followers of 
Mahomet. To these people, opium must be 
viewed as the mere substitute of vinous and 
spirituous potations ; and the charm of its ope- 
ration is to be sought in a peculiar excitement 
of the brain, sometimes quiet in its character, 
and attended by sensations of a subdued but 
highly-agreeable kind, or sensuous dreams, 
and visions of beatitude ; and, in other instances, 
from excitement of a more active or peculiarly- 
modified character, by an increased sentiment 
of courage and of high resolve, enabling them 
to brave death, in whatever shape it may pre- 
sent. Leaving aside, however, evidence of this 
sort, and directing our attention to that which 
we find in our own sphere of observation, some- 
thing like the- following may generally be ob- 
served after the lapse of about forty minutes 
in those who have taken a small or moderate 
dose of opium. A slight sensation of fullness 
of the head, or throbbing of the temples ; an 
increased glow of the whole cutaneous surface, 
terminating nearly always in perspiration ; ex- 
altation of the intellectual, moral, and imagi- 
native sentiments ; serenity of mind or the re- 
verse; visual perceptions of objects of a strange, 
uncouth, or frightful character; sooner or later 
obliviousness ; and, finally, sleep. From a larger 
dose there may be tension of the forehead or 
dizziness, redness and suffusion of the eyes, 
illusions, both of sight and hearing, confusion 
of ideas or delirium. To these symptoms, by 
a further increased dose, are superadded tension 
of the muscles, producing rigidity of the limbs, 
or unequal distribution of nerve-power, produc- 
ing trembling or convulsive movements, insen- 
sibility to surrounding objects, loss of conscious- 
ness, fixed, immovable features, contraction of 
the iris, drooping of the eyelids, palor, slowness 
and feebleness of pulse, sometimes a fullness of 
pulse, slow respiration, coolness of surface, and 
at length congestion so perfect as to simulate 
very nearly the apoplectic state. These phe- 
nomena and others often noticed, clearly indi- 
cate with what power opium directs its opera- 
tion upon the brain, although a part of them 
are equally dependent upon the spinal and 
ganglionic systems. 

The symptoms just detailed are presented to 
our observation in the normal condition of the 
organism in one unaccustomed to the action of 
opium, and presenting none of those numerous 
pathological conditions, whose existence so fre- 
quently calls for the use of this remedial agent, 
and modifies to such an extraordinary degree 
its operation upon the entire or separate divi- 
sions of the nervous system. As may be sup- 
posed, the different organs and functions of the 
economy come in for their share of the wide- 
spread influence of this agent. The digestive 
organs, in particular, partake of it, and it seems 
somewhat singular, that whilst the appetite is, 
as a rule, diminished, thirst is greatly increased. 
The loss of appetite, in this case, has been attri- 
buted to diminished secretion of bile and pan- 



October 20, 1860. 



MEDICAL SOCIETIES. 



63 



creatic juice, but a more plausible explanation 
may perhaps be found in a diminished nutrition 
and consequent depressed state of all the pro- 
cesses depending upon the nerves and centres 
of organic life. The constipation of bowels, so 
commonly noticed, may also be properly attri- 
buted to the same agency. Nausea and vomit- 
ing are of frequent occurrence, and, according 
to Trousseau and Pidoux, females are annoyed 
in this way, in the proportion of nearly three 
to one, as compared with males, thus showing 
that the more nervous the temperament, the 
greater the proneness to gastric disturbance. 
The secretions are in general diminished. So 
far, however, as the bile is concerned, a reason- 
able doubt may exist, that any diminution of 
this secretion occurs, other than the general 
depressed state of the nutritive function would 
render necessary. This condition of the organ- 
ism may, perhaps, in fact, account for all the 
changes observed in the secretions, no more of 
each being furnished than the exigencies of the 
economy may at the time require. Yet even 
here, anomalies are found to occur ; the secre- 
tion of urine, according to the showing of the 
authors above quoted, being increased in males, 
after four or five days use of the salts of mor- 
phium, in about one-fifth of the whole number 
of subjects. Perspiration is nearly always in- 
creased by a moderate or full dose of opium, 
and this increased activity of the cutaneous ex- 
halants is generally accompanied by an in- 
creased action of the heart and arteries, as is 
shown in such cases by increased color of the 
surface of the body. As in ordinary circum- 
stances, so, under the use of opium, an inverse 
relation obtains between the action of the kid- 
neys and that of the skin, and whilst the kid- 
neys in males, so the skin in females, is found 
to be as a general rule most active : and hence 
the more abundant perspiration in the latter, 
due perhaps to the greater delicacy of the der- 
moid tissue. It has been noticed that perspi- 
ration, produced by the external application of 
the salts of morphium to a denuded surface, 
shows itself first in the vicinity of the part to 
which it is applied ; but the same circumstance, 
I believe, has been observed in perspiration, 
occurring, as it often does, from the action of a 
simple vesicatory. The action of opium is 
more promptly manifested when applied in the 
form of one of the salts of morphium to a de- 
nuded surface than when received into the 
stomach ; and when injected into the cellular 
tissue or into the blood vessels is still more 
decided. When injected into the bowels, its 
action is likewise soon perceived, and, according 
to the testimony of most of the French writers, 
it produces even more powerful effects, used in 
this way, than when taken into the stomach : 
in explanation of which they allege it is less 
exposed to alteration by the juices, and is ex- 
empted from the action of the stomach. 

Our own experience, on the contrary, as that 
also of English practitioners, is decided in re- 



gard to its diminished power when so employed. 
Various circumstances pertaining to the indi- 
vidual tend to modify in a marked degree the 
action of opium upon the system. Other things 
being equal, the nearer to birth, the more sus- 
ceptible is the system to its influence. This 
circumstance has led some writers, of good 
standing, to doubt the propriety of its employ- 
ment in the diseases of young children, but, as 
we think, without sufficient ground. For, as 
the nervous system is that in which disease or 
commotion shows itself most frequently in 
young children, so is it that in which opium 
displays its most beneficial influence as an ano- 
dyne, sedative, or remedial agent. Eedoubled 
caution is alone required in these cases. Next, 
after children, females are most readily affected 
by opium, and many of them to such a degree, 
from its action upon the brain and stomach, as 
to render them wholly unable to support its 
operation, even in minute doses. There is 
reason, however, to believe, that in many seem- 
ing cases of this sort, when combined with 
proper correctives, and employed with great 
caution and strict regard to the peculiarities of 
the case, and persevered in, until a full trial 
has been made, the beneficial effects of the 
medicine might at length be secured. With 
opium, as with some other medicinal agents, 
intolerance of its action, on the part of the 
stomach or nervous system, will sometimes, 
after a few trials, give way. In instances of 
this kind, much will depend on the particular 
preparation selected, combination, and mode of 
administration. Excessive pain or cramp, and 
certain affections of the nerves, whose patho- 
logy is not well made out, modify to an extra- 
ordinary degree, or even wholly resist the 
action of opium, as we have evidence of in 
tetanus. 

As regards the particular mode of operation 
of opium, a great deal might be said, and yet 
in truth we know but little more than this : 
that whilst it seems capable of a diminished 
effect, from direct contact with the nerves, it 
owes its more powerful influences upon the 
human organism to absorption into the blood, 
as is clearly evinced in the fact of the narcotism 
of children, from imbibing the milk of a mother 
under the narcotic influence of opium. The 
system once brought under its action, symptoms 
either of excitement or depression may appear ; 
this depending upon the dose, lapse of time after 
taking it, idiosyncracy, condition of the stomach 
as to repletion or vacuity, state of the general 
system, or of some special organ, and many 
other circumstances, some of these known, and 
by far the greater part entirely beyond our 
ability, in the present state of pathology to fully 
appreciate. A moment's reflection will serve 
to show the role an article of such singular and 
transcendant powers must perform in Thera- 
peutics. As a medicinal agent, opium may, in 
truth, be said to be without a rival. Nor is it 
to be wondered that Sydenham should have re- 



64 



MEDICAL SOCIETIES. 



Vol. V. No. 3 



garded it as a gift of Heaven for the alleviation 
of man's sorrows and pains, nor that he should 
have said of opium — "w^ sine illo manca sit et 
claudicat medicina" — without it medicine goes 
hobbling along. If we but reflect upon the ex- 
tent and variety of the influences of this sub- 
stance upon the normal condition, we may form 
some idea of the extent of its applicability to 
the numerous pathological states to which the 
economy is constantly exposed. As before in- 
timated, many of these conditions are obscure 
in their manifestations, and a corresponding 
doubt and difficulty often besets the path of the 
practitioner as to the extent of employment or 
non-employment of this agent so potent for 
either the weal or wo of his patient. 

It is in this point of view especially incum- 
bent on the physician to attend closely to the 
various contraindications, and particularly in the case 
of children. As a rule, opium is not to be given 
in fever or inflammation with great arterial 
excitement and strong determination to the 
brain, nor in the reverse condition of great 
venous congestion, the latter being the more 
dangerous of the two. It is likewise contra- 
indicated when any known peculiarity of con- 
stitution leads us to fear apoplexy, In cough, 
accompanied with excessive bronchial secretion 
and great debility of the general powers, such 
as often exists in persons of advanced age, and 
in addition feeble pulse, the consequence of or- 
ganic disease of the heart, its use should, if 
possible, be avoided. But it is difficult to es- 
tablish rules in things of this nature, and they 
could at best meet hut a limited number of the emer- 
gencies constantly arising. The judgment of the 
practitioner at the necessary moment must be 
the guide. 

Exercising its influence mainly upon the ner- 
vous system, opium is found to be especially 
prompt and useful in its action in the class of 
diseases and commotions called nervous. No 
other article of the materia medica is compara- 
ble to this in its general power of calming the 
agitation and removing the malaise so often 
experienced in disease, nor in its efficacy in 
allaying exalted sensibility, subduing the sever- 
est attacks of pain, and in procuring repose and 
sleep. Of these various afl'ections, pain is the 
most difficult to bear, and, fortunately, in a large 
proportion of cases, it is that which is most 
amenable to the action of opium. The power 
of this medicine in allaying the most intense 
agony may well challenge our admiration and 
excite our surprise. The character of the pain, 
its location, and the particular state of the vital 
functions will enable us to determine the par- 
ticular preparation to be used, as well as the 
extent and mode of its employment. The dose 
necessary in some cases of purely nervous spasm 
or cramp is very large, yet in such instances 
it is seldom productive of ill consequences or 
material inconvenience. When pain is con- 
nected with vascular irritation or a degree of 
inflammation, a more moderate and prolonged 



use of opium is demanded. Inability to sleep 
is one of the most common, harrassing, and de- 
bilitating conditions we meet in practice. Its 
causes difffer much, some of them arising from 
transient and obvious reasons, others obscure 
in their origin, and still others depending upon 
constitutional proclivity. The first are, of course, 
most amenable to treatment, and consist chiefly 
in pain of greater or less degree, and in a certain 
(to the patient generally indescribable) feeling 
of malaise, maintaining a general nervous irri- 
tation of the whole system. In such cases, 
opium alone, or combined with antispasmodics, 
aflbrds the greatest relief. Yet as such a con- 
dition is very often the attendant of fever, either 
idiopathic or connected with inflammation, 
close attention should be given to the contra- 
indications, and the treatment modified accord- 
ingly. 

Of special diseases in which opium is more 
particularly employed, I will mention some of 
the more prominent, without, however, confin- 
ing myself to any strict order. 

In the treatment of Neuralgia, great relief is 
often obtained by a liberal and judicious use of 
opium. But here, again, the real origin of the 
affection is frequently obscure, and whilst many 
cases (no doubt of eccentric character) are sus- 
ceptible of amelioration or cure, others, owing 
their origin to causes of another kind, prove 
intractable to this and all other medication, 
and admit only of temporary relief. In such 
cases relief has been obtained by the injection 
of the cellular tissue over the track of the nerve 
affected, after the failure of the ordinary mode. 
The utility of opium in the management of De- 
lirium Tremens has been hitherto generally con- 
ceded. The chief difference of opinion was and 
yet is, in determining the proper dose and the 
frequency of its repetition. Here practitioners 
are still at variance, for whilst the rule with 
some is to direct opium untU sleep is obtained, 
others are disposed to hesitate after having 
fruitlessly given a number of very large doses ; 
and a third set are content with administering 
very small doses, and that with watchful so- 
licitude as to the effect. The number of cases 
of the affection in question in my own practice 
has been too limited to enable me to discrimi- 
nate which of these modes of treatment is most 
consonant with the pathology of this disease, 
or most conducive to the welfare of the patient. 
Whilst it is certain that persons have recovered 
from these attacks, after taking an amount of 
opium just as large as those we read of it is 
perhaps not so clear that they recovered in 
virtue of these inordinate doses. Constitutions, 
capable of resisting the operation of such an 
amount of opium as we both read of and know 
of, may fairly be supposed to possess no small 
share of recuperative energy. Be this as it may, 
the practice cannot be deemed otherwise than 
hazardous, and the patient, no doubt from time 
to time, suffers the disastrous results attaching 
to this excessive use of the medicine, a mode- 



October 20, 1860. 



MEDICAL SOCIETIES. 



65 



rate and guarded employment of opium in in- 
stances of this sort, aided, as the exigencies of 
each case may seem to demand, by alcoholic 
stimulus, will probably exhibit a more satisfac- 
tory statistical result. Sleep has, in cases of 
this kind, (as in many analogous states of the 
brain and nervous system,) often followed the 
sudden suspension of the medicine. 

In various spasmodic affections, external or in- 
ternal, depending for their exciting cause upon 
excessive pain, opium affords the quickest and 
surest relief. Where, however, no such excit- 
ing cause is discoverable, caution is to be ob- 
served, with a view to determine as nearly as 
possible whether the irritation productive of 
convulsion be of peripheric or centric origin, 
as in the former only can nauch benefit from 
treatment be expected. Of this particular class, 
the convulsions of children, occurring generally 
between six months and three or four years of 
age, are those most frequently demanding our 
attention. They are nearly always caused by 
the irritation of teething, or by intestinal irri- 
tation, from improper or undigested food. These 
convulsions generally assail suddenly, without 
apparent previous indisposition, though, in other 
cases, fever, with slight twitchings of the ten- 
dons, precede for a short time. In either case, 
after the evacua'tion of the stomach and bowels 
by an antispasmodic purgative or injection, if 
the case be pressing, and giving proper atten- 
tion to the state of the gums, an injection of 
laudanum and starch has often been productive 
of more benefit in quieting irritation and obvi- 
ating returns of the convulsive movements 
than I have usually seen from bleeding, leech- 
ing, and the various topical applications gene- 
rally resorted to in such attacks, although 
these may be necessary precautionary measures, 
in view of the tender organization of the brain 
in children, and its remarkable proneness to 



In the modus operandi of opium in relieving 
these and analogous affections of the nervous 
system, we may see a full exemplification of its 
extraordinary sedative and anodyne powers, 
when properly employed. Nor are these pow- 
ers confined to any one of the three great divi- 
sions of the nervous system. For in the affec- 
tions alluded to, it is sometimes the brain, some- 
times the spinal marrow, and at other times the 
nerves and centres of organic life that are most 
implicated. 

Now, whilst it would be exceedingly difficult 
to define the precise extent, to which any one 
of these systems might be involved, as com- 
pared with another, and still more difficult or 
impossible to appreciate the correlative movements 
of these different systems in a given case of disease, 
it may, perhaps, be doubted, whether in patholo- 
gical states we are not in the habit of attaching 
too much importance to the brain, and too lit- 
tle to the centres and nerves of organic life. 
The different affections, to which reference has 
been made, are chiefly eccentric or peripheral 



in their origin, and it is with this penpheral system 
that the sympathetic nerves and ganglia have their 
closest relation ; and the inference we think a ra- 
tional one, that the sedative and anodyne power 
of opium is exerted quite as much or more in 
allaying morbid irritability in this system, than 
in merely blunting the perception of this mor- 
bid condition in the brain. 

[7b he continued.^ 



EDITORIAL DEPARTiVlENT. 



PEEISCOPE. 



TREATMENT OF DELIRIUM TREMENS BY LARGE DOSES 
OF DIGITALIS. 



In the number of September 29th of the 
Medical Times and Gazette, Dr. Gr. M. Jones, Sur- 
geon to the Jersey General Hospital reports his 
treatment of delirium tremens by large doses of 
digitalis. As the subject is of considerable inte- 
rest, showing how large doses of this drug may 
be borne in certain conditions, we give Dr. 
Jones' views somewhat in full. 

"About twelve years ago I was called to see 
a patient with delirium tremens, residing about 
a mile from my house, who was almost in arti- 
culo. I prescribed a dose of chloric ether with 
tincture of opium ; but the wife, who came for 
the medicine, took, by mistake, a phial contain- 
ing one ounce of tincture of digitalis. I discov- 
ered the error, and was horrified when I heard 
that the patient had taken this dose ; but no 
less surprised than pleased when I also heard 
that, instead of being poisoned, he was very 
much better. Under ordinary treatment, I fully 
believed he would have died ; but after this sin- 
gle dose he rapidly recovered. Profiting by this 
hint, I began to give digitalis in all the cases of 
delirium tremens which came under my care in 
hospital and private practice ; and during the 
last twelve years I have adopted it in at least 
seventy cases — this effect of drunkenness being 
very common in Jersey. 

"As to the dose, experience has taught me that 
the best dose is half-an-ounce of the tincture given 
in a little water. In some few cases, this one 
dose is enough, but generally a second dose is 
required four hours after the first. In some 
cases, but very seldom, a third dose is called 
for ; but this hardly ever need exceed two 
drachms. The largest quantity I have ever 
given was half-an-ounce at first, half-an-ounce four 
hours afterward, and another half-ouncesix hours 
after that — making an ounce and a-half in ten 
hours. 

"As to the effects of these doses, my impres- 
sion is that the action is on the brain, not on 
the heart. The pulse, so far from being lowered 



6a 



PEEISCOPE. 



[VoL.V. No. 3. 



in force, becomes fuller, and stronger, and more 
regular, soon after the first dose. The cold 
clammy perspirations pass off, and the skin be- 
comes warmer. As soon as the remedy pro- 
duces its full effect, sleep for five, six, or seven 
hours commonly follows ; sleep is the guide as 
to the repetition of the dose. No action on the 
kidneys is evidenced by any unusual secretion 
of urine. Sometimes the bowels are slightly 
acted on, but not commonly. I have never 
once seen any alarming symptom follow the use 
of these large doses of digitalis. The only case 
I have lost since adopting this treatment had a 
tumour in the brain. In three only was other 
treatment adopted after digitalis had failed to 
procure sleep ; in other words, in sixty-seven 
out of seventy cases digitalis was the only medi- 
cine used, and sixty-six of these patients recov- 
ered. I do not mean that these are the exact 
numbers of those treated ; I am certain as to 
the death, but I may have had more recoveries. 
I am well within bounds in saying seventy cases 
in twelve years, and that all of them were well- 
marked cases of delirium tremens. Slight cases 
of nervous derangement after drinking I have 
seen in great numbers ; but I speak here only of 
such cases as required active treatment. My 
previous experience of the results of the treat- 
ment by opium, or some of its preparations, by 
anti-spasmodics, etc., had certainly been much 
less successful; the proportion of deaths was 
larger, and the recovery much less rapid. 
Again, I have treated more than one patient 
successfully by digitalis, who, in subsequent 
attacks elsewhere, has been treated by opium 
and died ; and in many of the cases in which I 
have used digitalis successfully, opium had been 
previously given without any good effect. 

"I will only allude to one case in illustration : 
On September 9, 1860, 1 was called to see a gen- 
tleman, 48 years of age, who was in a very 
alarming state, having been without sleep four 
days and nights, having been 'muddled' for two 
months before, and having previously had ' fits 
of the horrors.' He had been treated by 
another practitioner by opium in moderate 
doses, but had become worse, and when I was 
sent for it M'as the opinion of Mr. Spencer 
Wells and Mr. McCrea — who accompanied me 
in my first visit — that the case was as bad a 
one as they had ever seen ; certainly I never 
saw a worse. The pulse was almost impercep- 
tible ; the skin covered with cold, clammy per- 
spiration ; the face deadly pale ; the lips blue ; 
the hands tremulously grasping the air ; the 
eye expressive of great fear ; the mind gone ; he 
was muttering incoherently. With some diffi- 
culty I passed half an ounce of tincture of digi- 
talis down his throat in the presence of my 
friends. In a few minutes he became more 
tranquil, the pulse was felt more easily, and we 
left him. After four hours I found that he had 
not slept, but he was rather more sensible, less 
tremulous, and warmer. I accordingly repeated 
the dose. Three hours after that, as he had 



been still without sleep, though in other res- 
pects improving, I gave two drachms more, 
making ten drachms in seven hours. After this 
he had some sleep, and had slept at intervals 
during the night. The next morning Dr. Bal- 
lard saw him, with my other friends, and all of 
them were much pleased with the great im- 
provement manifested. He was sensible, his 
fears had disappeared, he was very slightly 
tremulous ; the skin was warm, the tongue 
moist, and the pulse full and regular at 90. The 
heart's sound and impulse were normal ; the 
bowels had acted once, and urine had been 
passed in natural quantity. After this he took 
some broth, drank freely of imperial and lemon- 
ade, but took no stimuli of any kind, or any 
other medicine. He slept uninterruptedly for 
three hours and a-half in the afternoon, and at 
intervals in addition. The next night was a 
good one ; and when he was seen by my friends 
again the next morning he was almost well, 
and calling out for a mutton-chop.-" 



PERCHLORIDE OF IROX IN DISEASES OF THE SKIN. 

As the result of numerous trials, M. Devergie 
arrives at the following conclusions : — 1. It is 
the most efficacious agent which has been em- 
ployed in the internal treatment oi purpura sim- 
plex and hccviorrhagica. 2. It may be employed 
with much advantage internally in the cachec- 
tic and anaemic condition which so often accom- 
panies certain forms of disease of the skin, as 
rupia, ecthyma, cachecticum, impetigo scahida, and 
atonic ulcers of the lower extremities. 3. It is 
not of the same value in active heemorrhages or 
in the acute forms of the diseases just named. 
4. Employed externally, in the liquid form, in 
different degrees of strength, it may exert great 
influence in modifying the condition of wounds; 
atonic, scrofulous, and syphilitic ulcers, and 
various forms of chronic disease of the skin, 
accompanied by secretion. Under its employ- 
ment obstinate morbid conditions have yielded 
which have resisted a great number of external 
agents. 5. Its use, in the form of ointment is 
most advantageous in the declining period of 
diseases with secretion ; but used in pretty strong 
doses ; it is also useful in certain squamous 
affections, diminishing the period of time ne- 
cessary for the application of such disagreeable 
substances as tar or cade oil. — Bulletin de Thera- 
peutique, tome Iviii. p. 297. 



APPARATUS FOR THE LOCAL APPLICATION OF STIMU- 
LATING OR ANESTHETIC VAPORS. 

Dr. Dewees, of New York, in a letter to Dr. 
Douglass, of the American Medical Monthly, de- 
scribes his apparatus as follows : 

Dr. Douglas : Dear Sir — In reply to your note 
respecting my instrument for etherization and 
vaporization in certain diseases of the ear, I | 
will furnish you with a drawing of its arrange- 
ment, and a description of its use, as employed 



October 20, 1860. 



PERESCOPE. 



6T 



by me, not only in aural disorders, but also in 
neuralgia requiring local ansesthesia, and some 
diseases of the spinal column in which topical 
irritation is called for, varying from an artifi- 
cial glow up to absolute cautery. 

The instrument originally used by me during 
the last fourteen years is still in my possession ; 
but, from the inconvenience and imperfectness 
attending vaporization by the heat of the hand, 
or by holding it in warm water, I have laid it 
aside, and have contrived the one to which you 
refer. This instrument (see cut) consists of a 
delicate Bohemian glass retort, with a nozzle 
projecting an inch and a half, perforated by a 
capillary aperture. The supply-tube of the re- 
tort rises about an inch above the level of the 
curved neck, thus allowing greater freedom in 
pouring in the fluid to be evaporated. A cork 
stopper, with an elastic cap or holder to prevent 
its expulsion, or a ground-glass capillary tube 
stopper, closes this entrance, the one or the 
other to be used according to circumstances of 
application. The retort, when charged with the 
fluid to be evaporated, is then lodged within a 
hard glass receiver, three inches high, having 
its rim lipped deep enough to embrace the pro- 
jecting nozzle of the retort, thus aflbrding 
greater steadiness, besides serving as a catch 
for the elastic band retaining the nozzle in its 
projection. Small nipple-like catches are stud- 
ded on the opposing centres of the rim of the 
receiver, to afford resisting points for the elastic 
back band, which passes from under the poste- 
rior rim across the front of the supply-tube. By 
these two elastic bands, the mobility of action 
is fully commanded in the projecting nozzle. 




The mode of using this simple but astonish- 
ingly effective little instrument requires but 
little practice to regulate it to the necessities of 
the case. About two drachms of ether are to 
be poured into the retort when secured in the 
receiver. The stopper should be firmly fastened, 
I and the finger can be readily placed over the 
nozzle aperture during or after the introduction 



of the warm water or sand into the receiver. 
A rushing or blowing sound of the escaping 
vapor or gas immediately ensues through the 
aperture, if uncovered. The nozzle is then in- 
troduced within the auricle, and a little experi- 
ence will soon teach the time and proper dis- 
tance (from the drum) of the application. Mode- 
rately warm water will only be required for sul- 
phuric ether, the degree of heat to be varied 
according to the specific gravity of the evapora- 
ble fluid, and according as a slow or rapid dis- 
engagement is needed. 

Besides its use in etherization of the ear, this 
little instrument affords in neuralgia the most 
elegant mode for the application of local anaes- 
thesia, the constant current from the evaporat- 
ing ether, chloroform, &c., being readily applied 
directly to the suffering part, and made to fol- 
low the course of the painful nerve. When it 
is wished to apply the anesthetic locally, I use 
a ring of adhesive plaster or of kid, to prevent 
the diffusion of the vapor over the surrounding 
parts. A common pill box, perforated to admit 
the nozzle of the instrument, and applied over 
the part, also answers well. In inhalation, or 
in etherization, through the Eustachian tube, 
the capillary glass stopper will be found prefer- 
able, as it admits a sufficient admixture of air, 
as well as an outward communication for breath- 

In certain spinal or nervous disorders, this 
instrument affords a most ready and exclusive 
mode of applying heat, which can be made to 
vary from a simple glow to the moxa or abso- 
lute cautery. This is effected by igniting the 
jet as it passes through the capillary tube of the 
nozzle, the amount of force being regulated by 
the evaporizing temperature employed, and the 
distance from the part. The circular protec- 
tion above mentioned is useful when the moxa 
is required. 

In some of the diseases of the ear where, be- 
side the anaesthesia to the inner nervous distri- 
butions, a local stimulant or irritant to the drum 
or the auricle is wanted, this instrument offers 
a ready method of effecting the desired end, viz. 
by adding to the ether, or other fluid, a volatile 
stimulant, as for instance, the ess. ol. sinapis, 
diluted. No practitioner should be without one, 
from the extensive capacity of the varied adapta- 
bility of the instrument. In diseases of the ear, 
or in neuralgia, it can safely be intrusted to a 
patient for self-application. Many volatile sub- 
stances can be directly applied through its 
agency.'^ 

Dr. Levis, of this city, accomplishes the same 
object, with probably as much efficiency, in 
even a simpler manner. He uses a bottle of 
almost any size, with a capillary glass tube 
perforating its cork. Ether is poured into the 
bottle, and the heating for evaporation effected 
by simply wrapping around it a towel or cloth 
which has been dipped into hot water and wrung 
out. 



68 



EDITORIAL. 



[Vol. y. No. 3. 



THE MEDICAL AND SURGICAL REPORTER. 



PHILADELPHIA, SATURDAY, OCTOBER 20, 1860. 



THE REVOKINa OF A DIPLOMA. 
A recent number of a prominent British 
Medical Journal lias an article referring to 
American diplomas, in which mention is made 
of a case which happened some years ago, and 
in the recital of which some slight errors have 
crept in, which we take occasion to correct, in 
order to bring the facts more prominently be- 
fore the profession here, as well as for the 
benefit of our transatlantic cotemporary. 

The case referred to is that brought before 
the American Medical Association by the New- 
ark Medical Association, in a complaint or me- 
morial addressed to the former body at its 
session in Washington in 1858, in which me- 
morial facts and testimony were jDublished, 
which showed conclusively, that the Faculty of 
the then New York Medical College, of which 
Dr. Horace Green was President, had bestowed 
their diploma upon a most ignorant and un- 
worthy quack, and that too when he had ful- 
filled hardly any of the requirements of gra- 
duation. 

The case in question is a type of many, and 
the precedent which it has established, is one 
of importance. The then New York Medical 
College is one of the things past — for though it 
bears the old name, the institution at present is 
entirely re-organized — and we feel that in speak- 
ing of the dead we can do so impassionately 
and with impartiality. At the same time it 
aifords an excellent opportunity to point out as 
a warning to others the ruins of bygone great- 
ness, for, after the memorial in question was 
brought before the profession, the New York 
Medical College went rapidly down, and nothing 
in the wide world could save it. Of course this 
galloping consumption may have been merely 
coincidental with the severe charges brought 
against the college. Yet we hardly think that 
even the most vigorous school in the United 
States would be able to stand in the position in 
which the New York Medical College did then, 
without coming away severely damaged. An- 
other reason why we allude to this matter now, 



is to call upon the profession throughout the 
country, especially the ofiicers of State So- 
cieties, to keep a watchful eye upon all such 
cases, and to institute vigorous measures when- 
ever medical schools, intentially or otherwise, 
abuse their privileges. 

The British journal referred to states that a 
complaint having been brought forward against 
the New York Medical College, the^ diploma in 
question was not revoked. This is simply a mis- 
take. If the reader will turn to vol. 11, 1858, 
p. 49, of the Transactions of the American 
Medical Associatien, he will there find the fol- 
lowing : 

" Dr. John Watson, of New York, from the 
Committee on Ethics, reported as follows : 

Whereas, It appears from undoubted testi- 
mony that the New York Medical College have 
conferred the degree of Doctor of Medicine upon 
a notorious quack of the name of John F. Dun- 
ker, of Newark : the Faculty, in the person of 
the President of said College, wish here to de- 
clare that the degree was obtained under gross 
deception, and false testimonials furnished by 
said Dunker and his friends, and they, there- 
fore, revoke and annul his diploma, and declare 
said Dunker to be unworthy of patronage or 
support, from authority conferred upon him by 
this diploma. 

Dr. C. C. Cox, of Maryland, moved that the 
report be indefinitely postponed: which was not 
agreed to. 

On motion, the report was then adopted." 

There can be no equivocation then, about this 
matter. The diploma has been revoked by the 
President of the College, as such, and the So- 
ciety in question has done essential service in 
establishing the precedent. Though, when vio- 
lating the trust and good faith put in them, 
medical schools may, perhaps, not be liable to 
be arraigned before the law of the State, they 
may be summoned, as in the case referred to, 
before the forum of the public professional 
opinion of the land in its embodiment, — the 
American Medical Association, and before it 
be made to acknowledge their error, and by re- 
voking their act repair the injury inflicted on 
the profession and the public. 



October 20, 1860. 



EDITOEIAL. 



69 



STILL ANOTHER DEATH FROM CHLORO- 
FORM—SHALL ITS USE CONTINUE ? 

A death from chloroform, at the Northamp- 
ton Infirmary, is recorded in the London Medi- 
cal Times and Gazette. The patient was about to 
submit to an operation for the removal of a 
small tumor from the back. Chloroform was 
administered cautiously. The testimony before 
the coroner's jury says that the effects of the 
an£Esthetic were soon visible upon the deceased, 
who became insensible without anything unu- 
sual being observed, although he was closely 
watched. On removing him into a proper posi- 
tion for performing the operation, it was ob- 
served that his countenance was very much 
changed. The suspicions of the operators were 
at once roused, and immediate steps were 
adopted for bringing the man to his senses 
again, instead of commencing the surgical ope- 
ration. Restoratives were resorted to, but to 
up purpose. Artificial respiration was then at- 
tempted, but this, too, was unavailing, and after 
an hour's futile endeavors at respiration, the 
deceased was reluctantly given up as lost. 

We record this case, not from any peculiar 
interest that it possesses, but that it may be 
added to the long, dark list which now stands 
against chloroform. All statistics of fatalities 
from chloroform which we have seen, are inac- 
curate, and far below the truth in their esti- 
mates, and we desire that every fatal case at- 
tributable to it may hereafter be presented. It 
is hoped that such cases, instead of being con- 
cealed, as they often have been, as if the unfor- 
tunate administrator felt guilty of homicide, 
will henceforth be published. We believe that, 
had all the deaths from chloroform been pro- 
perly noted, a list could now be presented which 
would astonish most of the advocates of its use, 
and do much in future to prevent loss of life by 
causing the discontinuance of its administra- 
tion. 

The practice of administering chloroform is 

rapidly decreasing in this country, and we some 

time ago predicted its discontii.uance for general 

anaesthetic purposes, and the substitution of 

ether. If its use is not lessening in Europe, 
6 



there is a growing want of confidence in its 
safety. The very caution with which European 
surgeons give it, shows that they use it with a 
consciousness of its danger. In the testimony 
of this case it was stated that the operator had 
the precaution to examine the deceased, " to 
ascertain if he was able to bear the effect of the 
chloroform.'' In the use of ether, which is now 
admitted to be almost absolutely safe, no one 
ever thinks of using such precautions, and it is 
now deemed admissible in any condition in 
which its angesthetic effects are desirable. 

We relinquished the convenient use of chloro- 
form with reluctance. When deaths under its 
administration became frequent, we still hoped 
that greater caution in its use, increased study 
of its physiological effects, further knowledge 
of the conditions which contra-indicate it, and 
a discovery of the constitutional idiosyncracies 
which make the administration fatal, would 
enable us to continue its use with safety. But 
the fatalities are now as numerous, as unex- 
pected, and as inexplicable as ever. Patients 
in vigorous health, and under the most cautious 
hands, continue to die when but little of the 
vapor has been inhaled, and sometimes at 
almost the first inspiration. 

In the present state of our knowledge of the 
mysterious fatal influences of chloroform, and 
its acknowledged uncontrollable mortality, we 
consider its ordinary use unjustifiable while an 
efficient and safe alternative for use is at hand. 
If the profession do not discontinue its use, pa- 
tients will soon refuse it. There is already, owing 
to its dangers, an increasing prejudice among 
the masses in regard to anaesthesia, in whatever 
manner produced, and if the use of chloroform, 
with its fatal accompaniments, continues, the 
popular verdict will condemn anaesthetics en- 
tirely, preferring to suffer pain rather than 
incur such a hazard of life. 



MEDICAL PROGRESS IN ILLINOIS. 
We are glad to learn that the Medical So- 
ciety of the city of Galesburg, 111., have adopted 
unanimously a series of preambles and resolu- 
tions respecting the legalization of dissecting in 
that State, and a better registration of deaths, 



TO 



EDITOEIAL. 



Vol. V. No. 3. 



births, and marriages. The following are the 
resolutions : 

Resolved, That we deem it wise and necessary, 
on the part of the Legislature of this State, to 
m.ake some provision which will admit students 
of medicine and members of the profession to 
supply themselves with material from subjects 
interred at the public expense, when not claimed 
by relations or friends, under such restrictions 
for the protection of the public interests and 
feelings as the delicate nature of the case may 
suggest. 

Besolved, That a law for the registration of 
births, marriages, and deaths, will contribute 
much to a better understanding of our climate, 
vital statistics, sanitary and industrial condi- 
tion \ to say nothing of the legal, historical, and 
medical knowledge otherwise accruing there- 
from. 

Besolved, That we hold the relation of physi- 
cian and patient to be of the most private, per- 
sonal, and confidential character ; and as such 
should ever be held inviolate, and as exempt 
from inquisitorial proceedings as those of the 
attorney and his client. That in accordance 
with these sentiments we claim that no person 
duly authorized to practice medicine and sur- 
gery should be compelled to disclose any infor- 
mation which he may have acquired in attend- 
ance on any patient in a professional character, 
and which information was necessary to enable 
him to prescribe intelligently, as a physician, 
or do any act as a surgeon. 

Besolved, That the statutes of the States of 
New York, Michigan, Iowa, Wisconsin, and 
Missouri, extending to the medical profession 
these legal privileges, are founded in justice 
and good morals, and have a proper regard for 
the peace of families and the coinmunity, and 
therefore receive our entire approval in meeting 
the wants of the profession in this State. 

Besolved, That at the proper time this Society 
will prepare a memorial to the Legislature 
calling attention to these, as we believe, right- 
ful statutory provisions, and ask for such enact- 
ments as the several cases herewith presented 
may require. 

Besolved, That we recommend similar action 
to other medical societies, and we solicit their 
active co-operation in carrying out the spirit of 
these resolutions. 

M. K. TAYLOE, M. D., President. 

H. M. STARKLorF, M. D., Secretary. 



We hope the example of the Gralesburg So- 
ciety will be speedily followed by every Society 
throughout the State, and that similar efforts 
will be made in other States into which these 
reforms have not yet found way. 



OUR MOETALITY TABLES. 

It affords us great pleasure to lay before our 
readers a letter from Dr. J. H. Griscoji, of New 
York, regarding our weekly table of mortality 
statistics. We have a few remarks to make 
regarding the valuable suggestions which that 
prominent sanitarian offers. 

First. We shall, of course, insert the popu- 
lation of each city as soon as we can get it re- 
liallij; of some we have already semi-official 
data. But, as this feature is only of relative and 
comparative value, we shall not commence with 
it until we can get most or all of the cities. 

Secondly. In reference to the still-births, they 
ought all to be inserted; but at present the 
miserable, unscientific mode of registration, 
with its bad arrangement and worse nomencla- 
ture, of most of the cities, is a check to any per- 
fectly-accurate statistics. We cannot force offi- 
cials to insert still-births, or to leave them out ; 
we have to rely upon their common sense to gra- 
dually bring their mortality reports up to a 
" sanitary '' condition. 

Thirdly. We have left a blank for ;;aren%e; 
but the difficulty is, that no Dr. Snow stands at 
the head of every health department of every 
city, and that in many cities there is no health 
department at all. To show under what diffi- 
culties we labor, we extract the following from 
a letter received from one of the most promi- 
nent physicians of one of our most important 
cities of the West : — 

" I do not know what I can accomplish in 
the way of getting weekly reports, but will try. 

" We have the most obstinate, selfish, stingy, 
and unenterprising Mayor in the States ; and 
no difference what benefits might accrue, ' What 
does it cost?' would be the answer." 

The fact is, we mean to educate ourselves 

and the health departments up to the verv best 

standard of statistical science ; to do this, we 

have all to commence as ' Abecedarians.' We 

shall hence be obliged for any suggestions from 



October 20, 1860. 



EDITORIAL 



71 



those wlio have entered the ' inner temple ' — 
only hoping that, for the present, there will be 
n fan It-fincVing. 



SUBSTITUTI^s^O NO^t.qfFICINAL FOR 
0FFICIIS\4.L PREPARATIONS. 

A medical gentleman, of this city, traveling 
South a few weeks ago, and spending some days 
in Baltimore, had occasion to prescribe for a 
friend, suddenly attacked with some disorder, 
the solution of morphia — meaning, of course, the 
officinal preparation, containing one grain of the 
salt to the ounce of water. It was only acci- 
dentally discovered that the druggist dispensed 
a solution containing sixteen grains to the ounce, 
and on further inquiry it was found that he 
had not even the officinal preparation, and 
that, unless especially designed, the strong so- 
lution was always dispensed, and that this was 
the habit of druggists in Baltimore generally. 
Thus only by accident the patient in this case 
escaped poisoning. We call the attention of 
our readers in Baltimore to the subject, and 
would be pleased to hear from them in regard 
to it. 



SPIRIT OF THE MEDICAL PRESS. 

The ISTew Orleans Medical Nevjs and Hospital 
Gazette speaks of the Progress of Medical 
Teaching in New Orleans. There is, perhaps, 
a pardonable degree of self-complaisance in the 
tone of the article, seeing that the Nevjs is the 
organ of the "second school," to whose influ- 
ence so much is attributed. The number of 
students, it says, has rapidly increased from two 
to six hundred. Moreover, the system of teach- 
ing has improved, and the Medical Department 
of the University of Louisiana has been com- 
pelled to follow the lead of the ISTew Orleans 
School of Medicine in teaching its pupils the 
"art of practicing medicine." "The New Or- 
leans School of Medicine raised the torch, and 
showed the path of progress, and one by one, 
willingly or unwillingly, the schools must file 
in." Prof. Lawson, late of Cincinnati, is an- 
nounced as the man who is to teach the pupils 
of the University the art of practicing medicine. 
The New Orleans school inaugurates this win- 
ter the teaching of Exj^erimental Physiology 
and Clinical Surgery, and the News claims that 
the example must be followed — by the Univer- 



sity, of course! We are very glad that the 
New Orleans School of Medicine has been po- 
tent for so much good, and hope that it will ex- 
ert its wholesome influence on all the schools of 
the country ! 

The Health of New Orleans, we are in- 
formed by the same journal, has been unusually 
good this season. Between the 7th of July and 
the middle of September, there were eight or 
ten deaths reported by yellow fever, though the 
News expresses some doubt about the cases 
being all yellow fever. The season has been 
one of the hottest ever known in the South, and 
the reported deaths by sun-stroke and apoplexy 
have been very numerous. The News expresses 
the opinion that far the greater number of cases 
reported as apoplexy were really sun-stroke. It 
gives the following record of deaths by these 
diseases : 





Sun-stroke. 


Apoplexy 


V'eek ending Julv 8th, 


7 


12 


" 15th, 


42 


40 


" 22d, 


4 


3 


" 29th, 


1 


'-r 
1 


Aug. 5th, 


o 


3 



On the subject of Medical Teaching in New 
Orleans the News seems to be a little beside 
itself. Its leading editorial for October begins 
with the health of the city by way of covering 
a good deal of self-glorification and gratulation 
on the subject of medical teaching in New Or- 
leans. It is scarcely worth while to "hear it, 
while it spreads itself," further than to say that 
it claims that its school has, in "four short 
years," made New Orleans the centre of medi- 
cal education for the South — (poor Nashville ! 
"Ichabod" is written on her walls!) — and in 
four more she will be ^'the medical centre af the 
Union'' — (alack-a-day, Philadelphia and New 
York!) 

The News very properly animadverts on the 
practice of physicians — members of the Ameri- 
can Medical Association — giving their names in 
recommendation of surgical instruments, as con- 
trary to the spirit of the Code of Ethics. 

The American Medical Monthly for Oct. speaks 
of the Opening of the Medical Schools of New 
York. It says that unusual preparations have 
been made, and that all the colleges of that city 
are prepared to begin the session of 1860-61 
with an ardor never before witnessed. It speaks 
in the following terms of the preliminary courses 
of lectures in the several colleges : 

" These lectures — introductory to the regular 
course, and extending through a month — are 



72 



EDITOEIAL— COERESPONDENCE. 



[Vol. V. No. 3, 



not exclusively given by members of the Faculty, 
but in many instances by aspirants to profes- 
sional dignities, for the enunciation of new views 
or new thoughts, as well as by those whose dele- 
gated province it is to teach. They often are, 
then, more interesting and quite as instructive 
as those of the regular course. The special 
subjects taken up are generally such as the lec- 
turers most delight in, and upon which they 
have observed much and studied much ; conse- 
quently they enter upon them with pleasure, 
lecture with more nerve, exhibit more origi- 
nality, abandon themselves to their own per- 
sonalities, and by their enthusiasm attract the 
student. This is the secret of the successful 
lecturer, and for these reasons, the preliminary 
courses given, as they frequently are by the pro- 
fessors and the attaches of the school, upon 
favorite subjects, become quite as important to 
the student as the regular course, and we trust 
that they will continue to grow in favor, and 
that each school will attract to itself those 
young men whose ardor leads them to investi- 
gate for themselves any special subject, and 
that the students will show their estimate of 
this plan by a rigid attendance upon them.'^ 

The Monthly speaks in favorable terms of the 
hospital enterprise in connection with the New 
York Medical ' College under its new organiza- 
tion, and hopes that it will speedily find imita- 
tors. The idea is certainly a correct one, and 
we trust that the New York Medical College 
will be enabled to give it practicable shape. 
We are glad to observe the tendency to attach 
medical schools to hospitals. 

The Nashville Journal of Medicine and Surgery 
for October furnishes little editorially worthy of 
comment, though we give place to the follow- 
ing, to which we would call the special atten- 
tion of some of our own correspondents : 

"We receive a great many letters which we 
cannot answer, because we do not know where 
they come from. A majority of people who 
write letters, in dating them, leave out the State. 
When a man writes from Philadelphia, New 
York, or Boston, he feels that it is not neces- 
sary to write after the names of these places, 
N. Y., Penn., Mass., for everybody knows where 
they are. But when he writes from Fisher- 
man's X Roads, Quincey's Store, New London, 
or New Amsterdam, he ought to know that no 
one but himself and the postmaster know where 
these places are. The postmaster, too, as if 
bent upon not being outdone by the correspon- 
dent, atiixes his post-mark in hieroglyphics 
that no one can decipher but himself. 

"Some time ago we received a letter from 

Concord, . It was an important letter, 

and we were desirous to answer it. We exam- 
ined the hieroglyphic post-mark. There were 
the dim outline of a ring across the stamp, and 
a C and alone visible. We went to our post 



office, and learned that there were all sorts of 
Concords in more than half the States in the 
Union. We had to give it up, and no doubt 
had many hlessiyigs for our ungentlemanly con- 
duct.'' 



New York, Oct. l^th, 1860. 

Messrs. Editors: — In your publication of the 
mortuary returns of the principal cities of the 
United States, in tabular form, which was com- 
menced in the first number of your fifth volume, 
you have, in my opinion, struck a most im- 
portant vein; one which, if carried out tho- 
roughly, will yield results of great value. It 
will, undoubtedly, cost you no little labor, time, 
and money, but you may be sure of a reward in 
the gratification which your readers will feel in 
having before them, every week, a perfect coup 
d'oeil of the sanitary condition of the country. 
It is sincerely to be hoped that you will secure 
all the necessary facilities for this interesting 
work, from the various places, and though you 
may find a difficulty at first, and your tables 
may be incomplete for a while, the publication 
must gradually stimulate the health authorities 
of ditferent localities to a willingness to place 
their records in your hands for such a colla- 
tion. There are some places, perhaps many, 
where no returns of mortality whatever are 
made up, which, by your publication, may be 
made to see the interest and value which per- 
tains to them. Among these instances may be 
mentioned so important a city as Albany, the 
capital of the most populous State in the 
Union. It has, I am told, no department to 
record the deaths of its inhabitants, and conse- 
quently no deaths are recorded ; the numbers 
of its annual dead are unknown to its own au- 
thorities and inhabitants ; no certificate of 
burial is required ; its people may be slyly poi- 
soned, or die from natural causes, and no one 
be the wiser for it, except the parties imme- 
diately interested, as the bodies quietly slip 
under the sod, without saying " by your leave" 
to any one. This careless and objectionable 
state of things ought to be stopped, if, for no 
other reason, than the danger to which the 
community is exposed, for want of a scientific 
appreciation of their own sanitary position ; a 
result to which, I believe, your tables will con- 
duce. 

Another valuable result from them will be 
one for which many efforts have heretofore 
been made, in several ways, but especially by 
the American Medical Association, but with 
very partial, if any success, I mean the adop- 
tion of a uniform svstem of resristration. This 



October 20, I860.] 



CORRESPONDENCE. 



73 



is a great desideratum, and the discussion of 
that question in your columns, together with 
the presentation of such a form of tabula- 
ture of diseases, as your experience may sug- 
gest, is the most likely means of directing at- 
tention to the subject, and causing a proper 
scientific and comprehensive system to be gene- 
rally adopted throughout the Union. 

I would like to make one or two suggestions 
of improvement of, or rather addition to, your 
form of table, for adoption at the proper time. 
1st. As soon as the recent census returns can 
be obtained, to give the population of each 
place in a permanent column. This will enable 
you to give the ratio of mortality, and so enable 
your readers to make a comparison of the state 
of the 23ublic health of each city with all the 
rest. A column, giving the ratio of some of the 
most important diseases, compared with the 
whole number, will also be a valuable addition. 

2nd. Some authorities affect to believe that 
the still births do not constitute a proper ele- 
ment of estimate of the sanitary condition of a 
population, and therefore either omit entirely 
to report them, or put them in such a position 
as not to be included in the general result. 
Taking an opposite view of this question, I hope 
you will continue to give them their proper 
place in the table, and that you will urge your 
correspondents to include them in their reports 
to you. The grounds upon which this view, is 
based are these : A still birth is the result of 
either crime or disease, (including accidents, 
malformations, &c.) It may be impossible to 
discover what proportion may be due to the 
former of these causes, but if we can know the 
whole number in all the cities reported, we 
certainly have a basis for some calculation of 
the general state of the morals of any particular 
community in this respect. 

As regards the still births due to natural 
causes, I regard them as very important indices 
of the health of the female part of the popula- 
tion. They tell of the mode of living, of the 
results of physical education, of the capacity 
for child bearing, of the value of professional 
interference, and other points of much interest 
in the welfare of the people, and are, moreover, 
a measure of the future strength of the State, 
for a still born child is as much of a loss as one 
that dies after birth. The increase of popula- 
tion of most places (in fact of all places not 
affected by immigration) is limited to the ca- 
pacity of its females to become mothers : hence 
it is very easy to see that incapacity in that re- 
spect must reduce the population of a place, 
pan passu, and of that incapacity, the number 
of still births maybe, of some particular locality, 
an important index. Besides this, I can name 
one large city whose registering officer has re- 
cently adopted the plan of throwing out these 
figures, in order to give a better comparative 
appearance to the mortality returns ; this offi- 
cial should, to be consistent, go a step further, 
and reject those deaths occurring within a few 



days after birth, as having no connection with 
the state of the public health, — and upon the 
same argument he might leave out all occurring 
within a year. Let the principle be universally 
adopted that no dead body should go unrecorded, 
and there can no harm result, while all will be 
better satisfied. 

3d. Another item which should be recorded 
is one whose importance has been recently 
elucidated very forcibly by Dr. E. M. Snow, of 
Providence, R. I., and which he now regularly 
reports. It is the parentage of the decedents. 

It is evident, on reflection, that the nativity 
does not always give a fair representation of the 
facts. You cannot have a better illustration of 
the value of this idea, than from the following 
quotation from the September report of that 
eminent statistician : 

"The mortality in September affords a good 
illustration of the difference between Nativity 
and Parentage in these statistics. The average 
age of those who died was as follows : 

According to Nativity or Birth-place : 

American nativity, 84 deaths ; average age, 
16.5 years. 

Foreign nativity, 10 deaths ; average age, 44.3 
years. 

According to Parentage : 

American parentage, 50 deaths ; average age, 
26.5 years. 

Foreign parentage, 44 deaths ; average age, 
11.4 years. 

If we deduct from the 44 persons of foreign 
parentage the 10 who were born in foreign 
countries, we have 34 children born in this 
country of foreign parents who died during the 
month. The average age of these 34 children 
was only one year and eight-tenths. 

Of the 23 children who died of cholera infan- 
tum in September, all were of American nati- 
vity: but only 7 were of American parentage, 
while 16 were of Irish parentage." 

I have prolonged my letter beyond my expec- 
tation at the commencement, and yet the topic 
is not exhausted.' Take my hurried droppings 
for what they are worth, while I remain, very 
respectfully, 

Yours, 

Jno. H. GrRISCOir. 



MEDICAL INSTITUTIONS IN DUBLIN. 

Philadelphia, Sept. 21, 1860. 
Messrs. Editors : — In your issue of the 8th 
inst., I have seen a letter dated " Cork, August 
19th,'' and signed " M. D. Abroad,'' purporting 
to convey an idea of the amount of medical 
and surgical relief afforded .to the sick poor of 
Dublin and vicinity, drawn from a short visit 
made by the writer to one of its hospitals and 
from whathesaw therein. As " M. D. Abroad's" 
letters to the Reporter are, I presume, pub- 
lished with the view of giving its readers a true 



74 



CORRESPONDENCE. 



Vol. V. No. 



description of the prominent medical institu- 
tions examined by him in the various European 
cities through which he has traveled, it may 
not be amiss to draw attention to some inaccu- 
rate statements in his letter with regard to the 
only hospital in Dublin which he visited, as 
well as to his omission of the names of most of 
the noble medical institutions in that city, of 
whose existence he does not seem to be even 
aware. 

As to St. Vincent's Hospital, he says, " It is, I 
believe, not quite as large as Steven's Hospital ;'^ 
and again, " it is now capable of accommodating 
nearly one hundred patients," &c. — the precise 
facts "being, that, so far back as the year 1852, 
St. Vincent's Hospital contained exactly one 
hundred beds, besides a large ward for the re- 
ception of children, on the plan of the " En- 
fans Malades," in Paris, whilst Steven's Hos- 
pital, established in 1720, contains over two hun- 
two hundred beds, besides distinct wards for 
venereal patients. St. Vincent's Hospital is 
■ visited every morning at eight o'clock by the 
physicians, surgeons, and pupils, and clinical 
instruction is daily given to the latter at the 
bed-side of each patient, besides the regular 
clinical lectures twice a week. Your corre- 
spondent mistakes when stating that " St. Vin- 
cent's Hospital is in the hands of the Roman 
Catholics ;" for, although attended by the Sis- 
ters of Charity, who act as nurses, the entire 
medical staff, including the consulting as well 
as the visiting physicians and surgeons, is, with 
a single exception, composed entirely of Pro- 
testants, amongst whom, by the way, was the 
late Dr. O'Brien Bellingham, whose name will 
be ever associated with the treatment of aneu- 
rism by compression as long as surgery con- 
tinues to be cultivated as a science. The Royal 
Plospital, to which your correspondent alludes, 
can scarcely be called a public hospital, as it 
admits none but disabled or superannuated 
sailors, whilst the Military Hospital, as its name 
implies, is intended exclusively for that branch 
of the public service.. The Workhouse or 
"Union" Hospitals, of which there are tioo 
very large ones, viz: the North and South 
Dublin Union Hospitals, are solely occupied by 
patients who are received from the workhouses 
only, and who, therefore, must be reduced to the 
condition of "paupers, whom nobody owns,'-* 
before being entitled to admission. 

Besides the above-named hospitals, "M. D. 
Abroad," if he only had a little more time to 
spare, could have seen, in Dublin, the follow- 
ing hospitals and other medical and surgical 
institutions, viz : The City of Dublin Hospital, 
established in 1832, containing 62 beds, be- 
sides two large wards for diseases of the eye, 
under Dr. Jacob, and one large ward for ute- 
rine diseases, under Dr. Beatty ; the Meath 
Hospital, establifdied in 1774, contains 100 beds ; 
the Rathdov/n Fever Hospital, established in 



1835, contains 26 beds ; the Hospital for Incu- 
rables, established in 1740, contains 100 beds ; 
the General Hospital of House of Industry, 
established in 1803, contains 300 beds ; the Na- 
tional Eye Infirmary, established in 1814, con- 
tains 6 beds ; Mercer's Hospital, established in 
1734, contains 60 beds ; Jervis Street Hospital, 
established in 1721, contains 80 beds ; Maison 
de Sante, established in 1816, contains 12 beds; 
St. Mark's Ophthalmic Hospital, established in 
1844, contains 20 beds ; Simpson's Hospital, 
established in 1779, contains 70 beds ; Sir Pa-- 
trick Dunn's Hospital, established in 1808, con- 
tains 60 beds ; Westmoreland Lock Hospital, 
established in 1792, contains 80 beds. 

In addition to these, there are four lying-in 
hospitals, viz : the Anglesea, established in 
1828, contains 10 beds ; the Combe, established 
in 1826, contains 40 beds ; the Rotunda, estab- 
lished in 1757, contains 140 beds, and averages 
2,000 deliveries per annum ; the South Eastern, 
established in 1834, contains 25 beds. 

At every one of the above hospitals, clinical 
instruction is given daih^, as well as regular 
clinical lectures twice each week. 

There are also in Dublin six general dispen- 
saries, from which patients receive daily ad- 
vice and medicine, as v^ell as medical attend- 
ance at their homes ; the average number of 
patients treated at these institutions for the last 
thirty years, (not including the hospitals,) 
amounts to 72,510 per annum. Besides, the 
two Universities mentioned by your correspon- 
dent, viz: Trinity College, and the Queen's 
University, (by the way one of the three col- 
leges connected with the latter is, ludicrously 
enough, located by your correspondent at Olas- 
gow,* which is a city in Scotland, instead of 
G-alway, in Ireland,) Dublin contains the King's 
and Queen's College of Physicians, an institution 
which has a "local habitation" as well as a 
name; the Royal College of Surgeons; and the 
Apothecaries' Hall. 

In conclusion, I need scarcely refer to a fact, 
well known and fully acknowledged, at least at 
the other side of the Atlantic, viz: that the 
medical colleges and universities of Dublin 
rank amongst the very highest in Europe as 
schools of medicine and surgery, whilst the 
numerous hospitals of that ancient city " con- 
taining only about one-tenth of the population 
of London, or not quite half that of Philadel- 
phia," stand forth as noble monuments of the 
benevolence and philanthrophy of the Irish 
medical profession, most of them having been 
founded, or partly endowed by members of that 
body. 

I remain, gentlemen, your obedient servant, 
M. D. AT Home. 



CJiolera, of a malignant character, after ex- 
isting some time in the southern part of Spain, 
is now affecting the troops at Gibraltar. 

*_Tliis Avas a typographical error.— EDiTor.s M. & S. Reporter. 



October 20, 1860. 



NEWS AND MISCELLANY. 



75 



THE COLLUSIONS BETWEEN PHYSICIANS AND 
APOTHECARIES. 

Philadelphia, Oct. 17th, 1860. 
Messrs. Editors : — 

I have been pleased to see that my letter, 
calling your attention to a vicious collusion 
between physicians and apothecaries, has, in 
"Esprit des Lois,'' attracted to the cause a 
spirited ally. I hope that this will not be the 
end of the agitation, and that it may terminate 
in the exposure of the guilty and the abandon- 
ment of the contemptible practice alluded to. 
This presenting of the " spirit'^ and letter of the 
*'law,'^ as quoted, may be beneficial to some 
who were perhaps not aware that their conduct 
made them amenable to rigorous punishment 
and disgrace. 

. That the vice was ever prevalent among " the 
best and most respectable apothecaries, and 
among some of our most distinguished and 
influential physicians and surgeons," is making 
a charge which surprises me, and seems rather 
to extenuate the guilt of the lesser, and more 
obscure sinners, who are now complained of. 

The practitioner to whom I alluded as an 
illustration of the vice, is not a member of any 
medical organization, and I cannot point out 
any member of a medical society whom I know 
to be certainly in the habit. I did not intend 
to imply that the villainous collusion exists 
more particularly in a northern suburban neigh- 
borhood, but desiring to present my own obser- 
vation of the matter, I did allude to its preva- 
lence to some extent in that direction. I am 
not a resident of a northern suburb, but from 
the knowledge of very many of the practitioners 
of the northern section of the city, I consider 
their professional tone to be generally as high 
as that of any central or southern locality. 

It is probable that the practitioners who are 
leagued pecuniarily with druggists, are rarely 
members of a medical organization, and cannot 
be made liable to censorial action. Such, how- 
ever, when known, are entitled to no profes- 
sional courtesy, and should not be tolerated in 
consultations. As regards druggists in the col- 
lusion, when not under the controlling influence 
of a pharmaceutical society, the remedy can 
only be in carefully avoiding the patronage of 
their stores. 

It is hoped, now that attention is attracted to 
the subject, that a watchful scrutiny will be 
exercised, by which any mercenary arrange- 
ment between physicians and druggists will be 
detected, and that the wide-spread influence of 
the Eeporter will continue to aid in its expo- 
sure. 

Esprit de Corps. 



NEWS AND MISCELLANY. 



OPENING OF THE CLINIC OF THE PHILADELPHIA 
HOSPITAL DR. LUDLOW's INTRODUCTORY AD- 
DRESS. 

The course of Clinical Instruction at the Phila- 
delphia was resumed on Saturday last. The 
recent action of the Board of Managers in open- 
ing the wards of the hospital, free of charge, 
promises, judging from the large attendance on 
Saturday, to be profitably appreciated. 

The students were welcomed by a spirited and 
instructive address from Dr. J. L. Ludlow, one 
of the physicians of the hospital. 

Dr. Ludlow congratulated his audience " that 
Philadelphia can still attract so many from an 
extended and extending country," and referred 
with pride to the medical institutions which are 
everywhere dotting our fair land, fostered by 
the influence of our matchless government. 
After some patriotic allusions to the broad field 
of science and literature upon which all the 
sons of a common country might reap the rich 
harvest of knowledge, and deprecating the at- 
tempts of those who would contract our limits 
to a "Pent up Utica," Dr. Ludlow announced, 
as the subject of his address — "The motives 
which induce young men to pursue the study of 
Medicine." The speaker observed that, for one 
unacquainted with the affairs or passions of the 
world, or who had not studied well human na- 
ture in all its phases, it might be presumptuous 
to attempt to penetrate the innermost recesses 
of the soul, or tell us motives which govern the 
actions of men ; but if we believe with the poet, 
"That the study of mankind is man," we are 
often enabled to dash the mask from the face 
of every deceiver, and by their deeds determine 
the motives which impel them to action, and 
from close inspection of, and deduction from, 
their motive, we are prepared to "play the 
prophet too." 

All act from motives. Sometimes we may 
think, or try to make others think, we are act- 
ing from one motive, but in the sequence our 
actions determine that we are acting from a dif- 
ferent one, and taking a large class together, 
and carefully watching their tone and actions, 
it requires no omnicient being to decipher the 
motives for the deeds performed, and in judging 
motives in this way, our profession will not 
suffer in comparison with any other. " By their 
fruits we shall know them." If any young man 
entered upon the study of medicine from heredi- 
tary motives, he will certainly fail, and the sooner 
he abandons the idea the better. There is no 
hereditary transmission of knowledge. King- 
doms may be handed down from father to son, 
but in the world of letters all are republicans. 
" In medicine we are princes by right of intel- 
lect, not because we have emerged from a royal 



76 



NEWS AND MISCELLANY. 



Vol. V. No. 3. 



womb.^' If any commence the study of medi- 
cine merely for the title, it would be much bet- 
ter for them to assume it at once, without sub- 
jecting themselves to unnecessary trouble. Many 
a sickly, feeble and tottering institution in our 
country, would confer it for a small endowment, 
less than it would cost to acquire a thorough 
knowledge of medicine. "Without even know- 
ing the applicant, the title of LL. D. has been 
thus bestowed, and there is no reason why M. D. 
should fare better. 

Those who espouse the profession of medicine 
merely for position in social life, must have forgot- 
ten that "Worth makes the man, the want of it 
the fellow.^' Mercenary motives induce another 
class to enter our profession. The acquisition of 
wealth in an honorable and laudable manner no 
one can object to. It is a powerful instrument 
in doing good, and incurs great responsibilities, 
as the rich man must give a strict account of 
his stewardship. We cannot affect indifference 
to money, but he who enters the portals of our 
profession with this motive alone, if he observes 
all the points of etiquette which the professional 
code enjoins, will soon find that no California, 
with its golden mines, will end his journey, and 
if he does soon begin to be rewarded for his 
labors, he becomes restless and reckless, and 
throws aside the restraints of professional eti- 
quette, and espouses the most promising delu- 
sion of the day, and bewildered by the magnifi- 
cent equipage and palatial dwelling of the quack, 
he soon forgets his Hippocratic oath, and be- 
comes a hypocrite in the worst sense of the word. 
If any enter with the idea of making a for- 
tune, be warned in time to go home — be a 
merchant — a planter — a farmer — anything but 
a doctor. He threw no obstacles in the way of 
those who have commenced the study of medi- 
cine for the purpose of perfecting their general 
education. Its various relations with the col- 
lateral sciences, and the various fields of inquiry 
into which it would lead them, he knew would 
improve their faculties, and make them wiser 
and better men. 

Dr. Ludlow then remarked that the grand, 
the glorious, the foremost inducement which 
influenced, and is still influencing, so many 
to choose our profession, is the benefit to hu- 
manity — the greatest amount of physical and 
mental relief to the greatest number. Some 
cavilers may deride this idea. To them the 
almighty dollar is the governing principle — the 
"sine quanon" of their existence; and they 
will often turn and ask, " If you are so humane, 
why take a fee V It is written in Holy Writ, 
that those who preach the Gospel should live 
by the Gospel. The good to be done to hu- 
manity does not imply that we should be pau- 
pers. It is no humanity to render a man mean, 
stingy, and miserly ; it is only the miser, the 
trickster, and the dishonest man who would 
ask us to render services to them without ample 
remuneration, accordiDg to the means they 
possess. 



The speaker referred to the great boon which 
the skillful physician conferred upon his pa- 
tients, and doubted whether he could ever be 
fully renumerated, so far as dollars and cents 
were concerned. Can money pay the physician 
who stands by the couch of an apparently 
dying loved one, and with skill and tact and 
tenderness, governed by an accurate knowledge 
of the disease, wards off the fatal shaft of the 
insatiate archer ? Can gold or silver be a re- 
compense to the sagacious surgeon who, with 
matchless dexterity, guards muscle and tendon 
and artery and nerve, as he dissects some ma- 
lignant growth, which is sapping the very ex- 
istence of his patient, and when the sick man 
walks forth restored to his wonted health in the 
bouyancy of his manhood ? Can money ever pay 
the man who has been the instrument of pro- 
longing his days and adding years to his exist- 
ence, and dispersing the dark cloud which hap 
long hung over him ? Humanity alone has in- 
duced those who have gone before you to labor 
in sunshine and storm, through long days and 
weary nights, mid pestilence and plague and 
famine — in the hospital and in the hut — in the 
cabin and by the way-side — in season and out 
of season — with only the idea of doing good. 
Eeckless of themselves and those to whom they 
were bound by the ties of nature and kindred, 
like heroes they looked for the fiercest of the 
fight, and boldly rushed on when cities were 
appalled and nations trembled for its people — 
when the stalwart man and the puny infant^ — 
when the man of wealth and the humble pau- 
per are alike stricken down — when pestilence 
ravages the land and turns kingdoms into huge 
charnel houses — then the eyes of all are turned 
to us for succor ; then we go forth to battle — 
our flag is thrown to the breeze, and upon it is 
inscribed, in letters of light. Humanity ! This 
motive for becoming physicians embraces all 
others, except the mercenary. Do you desire 
the title of Doctor ? It is justly yours. Social 
position? You have gained it. A branch of 
general education ? You possess it. But of 
money you most probably have very little. But 
what of that? 

I believe that you have devoted yourself to 
the study of medicine from the highest mo- 
tives ; that you have counted the cost, and are 
willing to abide the result ; that you will not 
lack the necessary appliances for perfecting 
yourself in your studies, the reputation of our 
colleges and their professors bear me out. To 
minister at the bed-side of the sick and the 
dying, is the humble privilege and duty of the 
physicians of this institution. No motive, 
except that of doing good commands our ser- 
vices. 

The Board of Management of this institution, 
acting from the same impulse, give their time 
and attention, and, with a feeling that this 
institution may be useful to you in prej^aring 
yourselves for the arduous duties of your pro- 
fession, have thrown open its wards for bed-side 



October 20, I860.] 



NEWS AND MISCELLANY. 



77 



instruction without fee or reward. It remains 
with you to avail yourselves of these privileges, 
and profit by them. 



Army and Navy. — Surgeon R. H. Coolidge 
will be relieved from duty in the Surgeon-Gene- 
ral's Office on the first of December next, and 
will then proceed, via Panama, to the Head- 
Quarters of the Department of California, and 
report for duty, as Medical Surveyor for the 
Departments of California and Oregon. Sur- 
geon Coolidge will be assigned to Benicia Bar- 
racks. 

Surgeon E. Murray will be relieved from 
duty in the Department of California on the 
arrival of Surgeon Coolidge, with directions to 
repair to Baltimore, Md., and report thence, by 
letter, to the Surgeon-General for further orders. 

Assistant Surgeon C. H. Smith has been as- 
signed to duty in the Surgeon-General's Office, 
and ordered to report in person to the Surgeon- 
General as soon as his present duties in Balti- 
more are completed. 



Duration of Life. — It is asserted that the aver- 
age length of life in France before the Revolu- 
tion of 1793 was twenty-eight years ; and that 
at the present time it is thirty-seven years. M. 
de Lapasse assures us, that if we would only 
live reasonably, we should reach to an average 
of 150 to 200 years ! This is what he calls the 
natural length of life. " The life of warm- 
blooded mamiferse is subject to an invariable 
law ; the duration of their existence appears to 
be equal to ten times the period of their growth. 
It is thus with the elephant, the ox, the cat, the 
dog, and the quadrumana. Two mamiferse are 
the only exceptions; the horse and the man. 
And why ? It is because they are slaves, — the 
one of the dire condition of work, and the other 
of his passions and the necessities of his social 
condition. — Med. Times and Gaz. 



The American Journal of Indigenous Materia 
Medica, and Repertory of Medical Science is the 
title in extenso of a journal announced to be is- 
sued next month in New York. We suppose 
that it is intended as simply an advertisement 
of the publishers, who are dealers in drugs. 

Medical Witnesses. — Judge Marsh, of Ohio, 
has decided that no medical witness can be com- 
pelled in court to give testimony involving a 
breach of professional confidence, and yet the 
statutes of that State only exempt clergymen 
and lawyers in express terms. 



We are gratified to observe the name of Dr. 
John Ordronaux in nomination for the Legisla- 
ture of the State of New York, from a district 
in the immediate vicinity of New York city. 
He is a gentleman of excellent attainments in 
both the professions of medicine and law ; has 
an excellent personal and hereditary record ; 
and is gifted with an eloquence rarely found in 



our ranks, and seldom excelled at the bar. His 
fellow-citizens will render a just tribute to mo- 
dest worth and the cause of humanity by his 
election, to whatever party he may belong. 



Prof. Titus Deville, of Lind University, has 
resigned the Chair of Anatomy here and re- 
turned to Paris. His place is filled by Dr. J. 
HoLLiSTER, while the Chair of Materia Medica 
and Therapeutics is occupied by Dr. A. L. 
McArthur, a new member of the faculty. 

o 

Ettsb3jerj5 to C^ornsponlrtnts. 

D. McO. — When we supply vaccine virus to sub- 
scribers, it is always without charge. We can 
generally oblige by sending it when requested ; 
and when practitioners have an excess of fresh and 
reliable virus, they can do a favor to some members 
of the profession, and a benefit to the community, by 
enclosing it with a record of the date of its procure- 
ment, to this ofiSce. There is a demand for vaccine 
virus at this time. 

MARRIAGES. 

Henry — Rand — On Tuesday morning, October 2, 
at the residence of the bride's father, Maysville, Ky., 
by the Rev. C. McKinney, T. Charlton Henry, of 
Kentucky, (late Assistant Surgeon U. S. Army,) to 
Lucie C, only daughter of Jacob W. Rand, Esq. 

Hance — RusLiNG — On the 4th inst., at the resi- 
dence of the bride's father, by Rev. E. H. Stokes, 
Edmund Hance, M. D., to Annie M., eldest daugh- 
ter of Gershom Rusling, Esq., all of Trenton. 
DEATHS. 

Mack — At Pennsgrove, N. J., on the 20th ult, 
Thomas D., youngest son of Dr. J. M. and Emily 

D. Mack. 

Communications Received. — Connecticut, Dr. G. 
A. Moody, (with end.,) Dr. F. A. Hart, (with end.,) 
Dr. C. C. Foote, (with end.) — Delaware, Dr. J. D. 
Craig, (with end.,) Dr. J. Hopkins, (with end.) — 
Illinois, E. D, Gates, Dr. J. M. Mack, Dr. E. C. 
Ellet, (with end.,) Dr. R. L. Rea— /ow;o., Dr. B. 
Hinchman, (with end.) — Kentucky — Dr. R. D. 
Porter, (with end.,) Dr. N, H. Baker — Missouri, 
Dr. F. V. Brokaw — New Jersey, Dr. L. S. Blackwell, 
(with end.) — New York, Dr. T. C. Brinsmade, (with 
end.) DrSi Allen and Rogers, (with end.,) Mr. W. 

E. Chapman, Dr. M. E. Murphy— OAw, D. W. 
Brinkerhoff, (with end.,) Dr. G. Liggett, (with 
end.) — Pennsylvania, Dr. B. Musser, (with end.,) 
Dr. W. Reichardt, (with end.,) Dr. J. Levergood, 
(with end.,) Dr. F. H. Bower, (with end.,) Dr. G. 
W. Burke, (with end.) Mr. J. Hulme, Dr. G. W. 
Smith, Dr. H. F. Martin, (with end.,) Dr. S. B. 
Himer, Dr. N. S. Marshall— ^oMi A Carolina, Dr. R. 
Wilson— Tennessee, Dr. T. M. Woodson, (with end.) 
— Vermont, Dr. B. W. Carpenter. 

Office Payments— Dr. G. R. Lewis, (Pa.,) Dr. B. 
M.Collins, (Pa.,) Dr. J. S. Thornton, (Pa.,) Dr. M. 
M. Manly, Dr. J. Rohrer, D. J. A. Meigs, Dr. E. B. 
Vandyke. By Mr. Swaine : Drs. Posey, Cox, Corse, 
McLerney, Garretson, Reese, Coad, Smith, Wittig, 
Craig, Trau, Price, Hunt, Griscom, Fricke, Lessey, 
Winckler, Ashton, H. St. Clair Ash, and Crew & 
Co. 



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THE 



MEDICAL AND SURGICAL REPORTER. 



WEOLE SERIES, 
NO. 210. 



} PHILADELPHIA, OCTOBER 27, 1860. 



NEW SERIES 
VOL.V. KO. 4. 



ORIGINAL DEPARTMENT. 

LECTURES. 

Lectures on tlie Crystalline Lens and its 



Delivered at the Howard Hospital 

By Lawrence Turnbull, M. D. 

Ophthalmic Surgeon to the Hospital. 

No. 3. 

OPERATIONS FOR CATARACT — DEPRESSION — RECLI- 
NATION. 

Of the numerous surgical operations by which 
man relieves his fellow man of the infirmities 
incident to his mortal state, there is not one 
which creates so much astonishment in the be- 
holder, and so much delight in the recipient, as 
the restoring of sight to the blind by the remo- 
val of an opaque lens from the eye. Time has 
familiarized the mind of surgeons with this 
operation, but the public view it with wonder 
and amazement half akin to awe. 

The ancients generally believed that cataract 
was produced by a pellicle, formed before the 
crystalline lens in the posterior chamber of the 
aqueous humor ; and even Galen defended the 
same opinion as late as the seventeenth cen- 
tury. About this time, some opaque crystal- 
line lenses were depressed with the needle, rose 
again, and passing through the pupil into the 
anterior chamber, were thence extracted through 
an incision made for that purpose in the cor- 
nea."'^ This led to the direct operation of ex- 
traction of the cataract in the year 1745, by 
Davieljf which almost supplanted the old opera- 
tion. After a time, by watching the facility 
with which nature dissolved and removed a 
lens by the introduction into it of the aqueous 
humor, a third operation was practised with 
success, namely, solution, termed also division. 



* S. Ives, Malad. des Yeux, Paris 1767, p. 237. 
t Mem. de 1' Acad, des Sciences, anno 1708, p. 242. 
7 



The terms, Keratonyxis and Scleronyxis, merely 
designate the coat — as the cornea or sclerotic — 
through which the instrument is to pass in 
either of these methods. A word of caution to 
the young surgeon before we commence the de- 
scription of the methods of performing the ope- 
rations for the removal of cataract. 

Study your case well before you attempt to 
touch the eye with the knife or needle, for far 
better is it for you to lose the opportunity of 
operating, than to do so, and fail to relieve your 
patient ; for he or she will be a walking index of 
your want of skill as long as life will last. Even 
the very best operators have made mistakes, 
and operated upon cases of diseased retina, from 
a simple want of care and attention on their 
part, and thus subj ected the patient to much pain 
and distress ; all through not studying their cases, 
well. The dangers, too, attending the opera- 
tions for cataract are much too lightly estima- 
ted in pronouncing an ultimate prognosis. The 
risk of a badly performed operation, and that of 
disorganization from inflammation and other 
causes, even under the most favorable circum- 
stances, are too much kept out of view. Such 
a thing as an unsuccessful case of operation for 
cataract is never published in our journals, and 
yet they are occurring at all times in this and 
other large cities, not only among the tyros of 
the profession, but in the hands of the most ex- 
pert surgeons. Many operators on the eye seem 
to think that they have done enough, when by 
the publication of a few successful cases, they 
have persuaded the profession and the public of 
their expertness ; but unless (as observed by 
Dr. Mackenzie) "the circumstances of each case 
are minutely detailed, and a history given, not 
of select cases, but of every case occurring du- 
ring a year, or longer period, and each history 
brought down not merely to a few days or weeks 
after the operation, but to a year or more, no con- 
clusion can be drawn regarding either the abili- 
ties of the operator, the merits of his particular 
mode of operating, or the general success of 
operations for the cure of cataract/^ 
79 



80 



LECTUEES. 



Vol. V. No. 4. 



Operations of Displacement — Depression — Recli- 
nation. — We will commence with a description 
of this, the oldest operation for the removal of 
cataract. It is stated that Griiy de Chauliac, 
who composed his work on Surgery in the four- 
teenth century, (1363) gives the following care- 
ful directions to the operator regarding the time 
during which he should keep the needle in con- 
tact with the depressed lens: namely, long 
enough to repeat a Pater three times, or a mise- 
rere once. 

The operation of depression was employed by 
the ancients in all forms of cataract, but at the 
present day it is considered only applicable to 
cases of hard cataract, and should only be pre- 
ferred to extraction, when the latter operation 
is found either impracticable or hazardous : — 
namely, when the globe is very deeply seated in 
the orbit ; when the palpebral aperture is much 
contracted ; when the anterior chamber is very 
small ; when adhesions exist between the pupil- 
lary margin of the iris and the anterior capsule 
of the lens ; when the globe has lost much of 
its natural elasticity; when the patient is ex- 
tremely feeble ; or when he or she is the sub- 
Jject of chronic croup or asthma. 

In couching, or simple depression of the cata- 
ract, the lens is placed by the needle below the 
level of the pupil. In reclination, the lens, at 
ithe same time that it is depressed, is also made 
to turn back on its lower and outer margin, so 
that it is forced back by its upper edge into the 
vitreous humor. Eeclination is to be preferred, 
because there is not sufficient room for the 
lodgement of a lens of normal or large size di- 
rectly below the pupil ; if simply depressed and 
not turned, it will be almost sure to re-ascend 
into its original situation, a result which the 
author has witnessed. It will therefore be well 
for the student to practice it well on the dead 
subject before he attempts it on an important 
living being. Indeed the most simple operation 
of the eye, should always be practised well in 
the dissecting room and upon the eyes of animals. 
The instruments required are a spring specu- 
lum and a pretty broad curved, lance-headed 
cataract needle ; in some instances a straight 
needle is employed. The first important matter 
is to' have the, patient in good health, and the 
digestion in good order. This is facilitated by 
the use of a mild laxative, or, in some instances, 
:tonics, for a week or two previous to the opera- 
tion. 

The eye should also be dilated with a solution 
of the sulphate or nitrate of atropia dropped 



into the eye the night before, or the soft extract 
of belladonna painted around the brow. The 
day should be clear, the weather moderate. 
The patient should take a very plain meal, and 
the operation should never be performed imme- 
diately after dinner ; especially is this necessary 
if the use of sulphuric ether, or a mixture of 
ether and chloroform is desired on the part of 
the patient. 

A solution of morphia, or a pill of opium, is 
sometimes employed previous to operating, but 
a careful inquiry should be made if there is any 
idiosyncracy, as many persons are affected by 
opiates so as to induce vomiting ; if such is the 
case it should be carefully avoided. 

The patient should either be seated on a low 
chair, or reclining on a couch or sofa, near a 
window, so that the light may fall obliquely on 
the eye ; and the surgeon should be seated im- 
mediately opposite the patient, but somewhat 
higher. An assistant should support the pa- 
tient's head, and fix the superior lid either with 
his finger or the elevator of Pellier. A needle 
is thrust through the sclerotic, at a short dis- 
tance from the outer margin of the cornea, as I 
now show you, and a little below its equator. In 
its progress, it passes first through the conjunc- 
tiva, next the sclerotic, choroid, retina, and hya- 
loid membrane, into the vitreous humor. When 
this point has been reached, it is carried on be- 
hind the iris until it becomes visible in the 
pupil. 

The capsule is then lacerated with the needle, 
which should be steadily pressed against the 
anterior surface of the lens, a little above its 
centre, so as to force it to leave its natural situa- 
tion, after which it is pressed backwards, down- 
wards, and outwards, into the vitreous humor. 
This being accomplished, the convexity of the 
head of the needle, by rotating the handle, is to 
be applied against the lens in order to com- 
plete the depression. 

Having kept the needle applied against the 
depressed lens long enough to see that the cata- 
ract does not re-ascend, the surgeon brings the 
head of the needle back into the posterior 
chamber by moving the handle a little back- 
ward, and withdraws it carefully and slowly. 

The instrument should always be introduced 
at a sufficient distance from the junction of the 
cornea and sclerotic (say about l-16th of an 
inch) to avoid the ciliary processes ; and from 
the transverse axis to avoid the long ciliary 
artery. The lens should be reclined before it ia 
depressed, to prevent the risk of its coming in 



October 27, 1860. 



LECTURES. 



81 



contact witli the retina ; and it should be car- 
ried backwards, to place it clear of the iris. 

The operation can be performed through the 
cornea, but as the posterior-capsule cannot be 
opened, it is considered much more hazardous 
to the e3^e. 

If the operation succeed, the restoration of 
vision is complete, provided the retina is in 
good condition. 

After-Treatment. — The eyes should be covered 
with a linen bandage, and should not be ex- 
amined for four or five days, and then only ex- 
posed to a moderate degree of light. In the 
course of one or two months cataract glasses 
may be used. 

Inflammation of the iris, or of the retina, or 
of the whole eyeball may set in, and when this 
does occur, it is generally fatal to vision. Free 
leeching, with active purgation, may do much 
to relieve the patient, with the free use of solu- 
tion of atropia, but, as the lens usually acts as 
an extraneous body, no medical agent is of 
much service. When, however, the inflamma- 
tion arises from injury by the needle, it may be 
subdued by the means above mentioned, and 
the influence of mercury. The cataract, when 
depressed, will often remain without change 
for years, even when deprived of its capsule, 
and is liable to rise from the vitreous humor 
by any sudden and violent exertion, as cough- 
ing, sneezing, etc. I, therefore, would not re- 
commend this operation to you as one which 
yields very satisfactory results. 

Professor Pancoast, of this city, has modified 
this operation by employing a hooked needle 
with which he draws the lens horizontally 
backwards into the vitreous humor, by sinking 
the needle in the hard lens after lacerating its 
capsule. The steps of the operation are much 
the same as those already stated. His needle 
is very small, and has a curve almost rectan- 
gular. " By this process," he says, "the eye 
is as little disturbed as possible, and the lens 
rests in the interior of the hyaloid tunic, and 
not in contact with either one oi the more deli- 
cate structures of the ball, the iris, the ciliary 
body, or the retina, and with no tendency to 
resume its old position." He punctures the 
sclerotic coat at a distance nearly equal to the 
diameter of the lens behind the margin of the 
cornea. We have here still a great risk of 
wounding the iris, and in sinking a needle in 
the lens, we have rather a combination of dis- 
placement and solution. We have also a foreign 
body remaining in the vitreous humor, heavier 



than it, and liable to sink and come in contact 
with the retina ; and, as it is a foreign body, 
apt to create inflammation in time in this loca- 
tion. 

As observed by Mr. Dixon, "The various 
mishaps that attend the operation of extraction 
are evident to every bystander ; but in depres- 
sion, or even reclination, provided the cataract 
disappears from the pupil, all seems to have 
gone well. The mischief that may have been 
inflicted on deep-seated structures cannot be 
detected ; and it is only in the course of weeks, 
or months, that a train of symptoms sets in 
which long after the operation may terminate 
in utter loss of sight." 

The objections to the "displacement of a 
cataract" are thus expressed by Mackenzie, 
and I am happy to have the weight of his au- 
thority in aid of my own: — "The principle on 
which the operations of 'displacement' are 
founded, is essentially bad. As well might we 
expect to lodge an entirely foreign body within 
the eye, and yet no continued irritation take 
place, no disorganization follow of the delicate 
textures with which it remained in contact, 
and no interruption happen to the function of 
the organ, as that the lens could be pressed 
into the vitreous humor, and lie there close to 
the retina, and the eye continue healthy and 
vision be preserved. Reclination or depression 
is to be thought of only when some insuperable 
objections exist to division and extraction. I 
assign them this low rank in the scale, not be- 
cause the lens is apt to re-ascend after being 
displaced — for that I consider rather a favor- 
able event, from the chance it gives of the cata- 
ract dissolving after its re-ascension — but be- 
cause chronic inflammation within the eye, 
dissolution of the hyaloid membrane and 
amaurosis are, I believe, the almost inva- 
riable results of a cataract, of any considerable 
bulk, continuing undissolved in the situation 
assigned to it by displacement."* 



Experience fully warrants the inference that 
mercury is a general stimulant to all those 
functions of organic life which are performed 
under the innervation from the ganglia of the 
sympathetic system. It is probable that its 
action is upon these ganglia. Thus, mercury 
tends to diffuse and equalize secretion, and the 
circulation of the blood, aiding, in this way, to 
break up local congestions and inflammations. 
— Hartshorne^s Medical Principles. 

* Mackenzie, Foxirth Edition, (English,) p. 835. 



82 



COMMUNICATIONS. 



Vol. V. No. 4. 



COMMUNICATIONS. 

Anatomy in its Relations to Medicine and 

Surgery. 

By D. Hayes Agnety, M. D. 

Lecturer on Anatomy, Surgeon to Pbiladelphia Hospital, etc. 

No. 32. 

Oral Region [continued.) — Within the cavity of 
ihe mouth the most prominent constituent is 
the tongue. Forming the floor of the mouth, it 
lies very accurately within the dental arch of 
the lower jaw. 

Glossal Connexions. — On the sides and in front 
it is connected to the inferior maxillary bone by 
the mucous membrane passing from one to the 
other. "When the tip is turned up, this mem- 
brane is seen to gather itself up into a fold or 
cord, the ''frcenum linguce.^' This runs from a 
groove on the under surface of the tongue to 
the symphisis of the jaw. On each side of the 
frsenum may be seen a blue line; these are the 
ranine veins. On each side of the same cord, on 
the floor, a somewhat lobulated projection is 
visible, covered only by the mucous membrane; 
they are the sublingual glands, which open into 
the oral cavity at this situation by numerous 
small excretory ducts. On each. side of the frse- 
num open likewise the Whartonian, more proper- 
ly, submaxillary ducts. Posteriorly the tongue 
is connected to the epiglottis by three folds of 
mucous membrane, the ''■glcsso-epiglottic" the mid- 
dle one of which is called the '■'■frcenum epiglotti- 
dis." The angle at which these rise from the 
organ under consideration to the epiglottis pro- 
duces a little pocket on each side of the frsenum. 

From the soft palate, on either side, pass down 
two crescentic folds of mucous membrane to the 
sides of the tongue, forming the anterior posterior 
palatine arches. These folds enclose muscular 
fibres, which will be more particularly noticed 
in another place. To the hyoid bone it is at- 
tached by the hyoglossi muscles, and to this 
same bone and the inferior maxillary on each 
side of the symphisis by the genio-hyoglossi 
muscles. With the styloid processes of the tem- 
poral bones it is connected by the stylo-glossi 
muscles. The tip is the freest part of the organ. 

Structure. — The tongue is covered by mucous 
membrane, has a depression, or raphe, running 
from the tip toward its root, and beset with nu- 
merous eminences, called papillcB. These are 
arranged in three groups : 1st. From eight 
to sixteen very large, and disposed in the shape 
of the letter V, the apex being directed back 



toward the root ; these are the papillce maximce, 
or circumvallatcB. 2d. The papillce medice or 
fungi form the next in size, and possessing a very 
red color, distributed irregularly over the sur- 
face, though most numerous along the margin, 
and especially'at the tip ; and, 3d. The papilla 
minimce or Jili/ormes, existing in great num- 
bers, and arranged in oblique rows on either 
side of the median line, and of a light color. 
These papillae are all elevations of the mucous 
and sub-mucous tissue of the tongue, enclosing 
blood-vessels and nerves, and covered by an 
epithelium. They, however, possess some points 
of distinction among themselves, which may be 
noticed in a general way. The papillas maxi- 
mse are inverted cones, with the apex of each 
attached at the bottom of a little depression or 
cup, are very vascular, and contain great num- 
bers of nerves. The papillse medias possess a 
degree of firmness and resistance which do not 
belong to the others, and which result from the 
amount of connective tissue they contain and 
their horny covering. They are all surmounted 
by secondary eminences, and covered by a flat- 
ened epithelium, except the medise or conicse, 
in which they are prolonged into brush-like 
processes. 

Numerous mucous glands exist over the 
tongue, as, for instance, at the root a group 
which do not extend beyond its middle ; along 
the sides near the root others, which open be- 
tween vertical folds of the mucous membrane ; 
and, last, beneath the tip, a cluster being placed 
on either side. The last two groups are so 
deeply placed as to be greatly influenced by 
the muscular fasiculi of the muscles, among 
which they lie. These are racemose in their 
form. 

Between the papillae maximse there are nu- 
merous simple follicles, which in their structure 
resemble the agmenated glands of the intestine, 
and over the capsules of which is a very fine 
plexus of blood-vessels. The contents of these 
glands are fluid, intermixed with granules, the 
former having an alkaline reaction, and the 
latter consisting of nuclei and cells. On the 
addition of acetic acid, no mucus is precipitated, 
nor is their secretion to be regarded as such. 

The great bulk of the tongue is made up of 
muscular and adipose tissue, containing but a 
small amount of fibrous tissue. It is divided in 
the middle by a vertical septum of ligamentous 
fibres. The muscular structure is disposed in 
three directions — vertical, transverse, and longi- 
tudinal. The first formed by the radiating fibres 



October 27, 1860. 



COMMUNICATIONS. 



83 



of tlie genio-glossi muscles, which, originating on 
either side of the mental symphisis, expand 
into the organ from its root to the tip, not, 
however, quite reaching the mucous membrane ; 
the second, called tranversus lingum, intersect, with 
considerable regularity, the fibres of the genio- 
glossus, running from the side to the median 
septum. The longitudinal fasciculi occupy both 
the upper and lower surface of the tongue ; the 
longitudinalis superior is placed between the mu- 
cous membrane of the dorsum and the superior 
fibres of the genio-glossus and transversus ; the 
longitudinales inferior is situated between the hyo- 
glossus and genio-glossus : the direction of both 
these muscles is from root to tip. 

Blood-vessels. — These come from the external 
carotid, and are the/acia^, ^m^^'wa^ ojn^ -pharyngeal. 
The second, or Unguals, are the ones principally 
concerned, and, under the name of ranine, rush 
along the under surface from root to tip, ap- 
proaching each other as they advance' forward, 
and only covered by the mucous membrane of 
the mouth. Alongside the arteries are situated 
the ranine veins, which end in the facial beneath 
the lower jaw. These vessels are quite appa- 
rent as two blue lines, seen when the free end of 
the tongue is turned up. 

Nerves. — These are the gustatory branches of 
the fifth pair, conferring, probably, common sen- 
sibility ; the hypoglossal, or ninth pair, dis- 
tributed to the muscles and imparting motion ; 
and the glosso-phryngeal, a portion of the eighth 
pair, and perhaps endowing with the special 
sense of taste. The first and the last are dis- 
tributed to the lingual papillae. 

Practical Remarks. — The tongue may be so 
bound down at the top by a short frgenum as to 
demand an operation. This defect is usually 
congenital, and is called tongue-tied. The incon- 
veniences resulting are imperfect nursing, and, 
later in life, imperfect articulation. The anxiety 
of mothers about their little ones will often in- 
duce them to present such to the physician, 
under the impression that the tongue is not suf- 
ficiently free, when this is not the case. As long 
as the child can carry the organ upon the lower 
lip there exists no necessity for interference. 
"When an operation becomes necessary, it will 
consist in a division of the frgenum. This is 
very simple, and yet, if ignorantly done, may be 
followed by bad consequences. I have seen a 
large cystic tumor form beneath the tongue, in 
consequence of a bungling operator penetrating 
the floor of the mouth, and doing violence to the 
sub-lingual glands. The anatomical relations 



will naturally suggest the division of the fras- 
num midway between the under surface of the 
tongue and the floor of the mouth, as by so 
doing the ranine vessels on the former will be 
avoided, and the sub-lingual gland beneath the 
latter. Nor will it be necessary to cut deeply, 
only a very slight nick, as the constant move- 
ment of the tongue will soon elongate the re- 
sisting the tissue. The instrument best adapted 
for the operation will be the probe-pointed scis 
sors. 

There is another variety of the tongue-tie 
which is due to a preternatural shortening of the 
genio-hyo-glossi muscle or muscles, and which 
may give rise to stammering. As this must be 
attacked from the neck, I shall pass it over 
until that region is reached. 

A tumor is met with beneath the end of the 
tongue, rising from the floor of the mouth, to 
which the name ranula has been applied. It 
involves the ducts of the sub-lingual glands, the 
excretory orifices of which here open. These 
become obstructed by some substance, either 
mechanical or inflammatory, the secretion accu- 
mulates behind, distending them finally into a 
semi-transparent tumor. Sometimes they are 
found to be firm and resisting in the texture. 
In such cases the distension has provoked an 
inflammatory exudation and its organization 
into fibrous tissue. The transparency will de- 
pend upon the attenuation of the mucous mem- 
brane. This same morbid condition may be 
present in a very limited degree, confined even 
to a single duct, so as to resemble a little vesi- 
cle. The cure of such can rarely be accomplished 
by puncture and evacuation of the contents, 
the wound you make will soon heal, and as the 
duct or ducts are not restored to a pervious con- 
dition, the swelling will be reproduced. No 
treatment short of that which contemplates the 
destruction of the glandular tissue will prove 
efiectual. This is best attained either by injec- 
tion or excision, the latter, I think, the prefera- 
ble, which is readily done by including the mass 
within two elliptical incisions, and then allow- 
ing the wound to heal by granulation or stitch- 
ing the edges together with the finest silver 
wire. If it be a small cyst, after clipping it 
away, the point of a stick of caustic may be 
carried into the wound for a moment or so. 

Another tumor is found in this same locality, 
and which is produced by a salivary calculus 
becoming arrested near the outlet of the sub- 
maxillary duct ; and, last, another variety of 
tumor, which I am disposed to believe is rare; 



84 



COMMUNICATIONS. 



Vol. V. No. 4. 



and being connected with the under surface of 
the top of the tongue, rather than the floor of 
the mouth, must be referred to the cluster of 
glands there situated. The sides of the tongue 
may be bound down by cicatricial tissue, so as 
to interfere with its proper functional move- 
ments. Should a nerve filament happen to be 
included, it may give rise to a very painful con- 
dition. This is best remedied by incissions or 
exsection of the diseased structure. 

The surface of the tongue, being an index to 
much which may be going on in other organs, 
is considered as a matter of great moment by 
the physician. These conditions may be such 
as effect temperature, color, size, movement, and 
secretion. 

A cold tongue is indicative of great danger. It is 
seen in the collapse of cholera, and, in some mias- 
matic fevers, attended with profound congestion 
of the internal organs, and always betokens the 
absence of peripheral circulation and the usual 
chemical combinations in the lungs ; the breath 
in such patients is cold, and shudders one with 
its unnaturalness. Preternatural heat may re- 
sult from inflammation of the organ itself, or 
even of distant ones, as the stomach, &c. 

Color. — A pale tongue implies debility or alte- 
ration in the blood. Its capillary vessels are 
empty ; the papillae will, consequently, not be 
prominent. It is seen in the latter stage of 
fevers, and will call for the exhibition of tonics, 
nutritious diet, and, perhaps, stimuli. When 
present in anemia it reveals the degree in which 
the red corpuscles are deficient. 

The red tongue must not be misinterpreted. 
It may have such a color from inflammation of 
its own, or any of the structures of the mouth ; 
from irritating substances taken into the mouth ; 
from an overcharge of the circulating fluid with 
red corpuscles ; from a very vigorous reaction 
after a chill ; from loss of epithelium ; and from 
gastritis or enteretis. Careful inquiry will, gene- 
rally, be sufficient to correct any misapprehen- 
sions. This color being dwelt much upon in in- 
flammatory states of the stomach and intes- 
tines, often, doubtless, misleads the practitioner. 
Unless other symptoms be present, pointing to 
abdominal disease, its evidence alone must be 
regarded as negative. 

Size. — The size of the tongue, leaving out, of 
course, alterations of structure, is determined in 
a great measure by causes which implicate the 
nerves. "When large, it exhibits a want of tone 
in the muscular fibres of the organ, and will be 
found to accompany a flashy condition of the 



general muscular system. In diseases attended 
with much nausea it is found to be present ; also, 
in conditions in which the functions of enerva- 
tion are impaired. It is certainly, even when 
no complaint is made, an evidence of a want of 
constitutional vigor. 

The small tongue is known to be present in high 
states of inflammatory intracranial disease, as 
meningitis, cerebritis, &c., and, in addition to the 
diminution in size, is frequently quite sharp or 
pointed at the tip. These characteristics are due, 
I suppose, to the increased functional activity of 
the nerves supplying the organ, induced by the 
inordinate amount of blood conveyed to the en- 
cephalon. 



Operation for the Relief of Extensive Adhe- 
sions between the Ball of the Eye and the 
Lids. 

By A. G. Walter, M. D., 

Of Pittsburgh, Pa. 

Adhesions which the ball of the eye at times 
contracts with the eyelids, in consequence of 
burns from cinders, iron, steam, and caustics, 
during mechanical operations, are of frequent 
occurrence, and, when extensive, have been as 
difficult to remove as it has been to prevent 
them. Deformity is the general result ; the eye- 
lids adhering to the ball impede free motion, 
and irritate the delicate organ by the constant 
tension to which it is thus subjected. 

Various have been the means resorted to for 
removing this vexatious deformity. Free in- 
cisions of the cicatrix, with temporary separa- 
tion of the lids by the aid of plaster strips, or an 
ansa, drawn through the margin of the lid and 
confined to the cheek or forehead — incision fol- 
lowed by cautrization — excision of the abnor- 
mal plastic product, in conjunction with care- 
ful eversion of the lids — a leaden wire passed 
through the base of the cicatrix, and retained 
until cicatrization of the fistulous track made 
by the wire has been effected, with subsequent 
section of the plastic bond between the wire 
and the terminal adhesions on the ball, on the 
same principle as digiti connati have been 
treated ; these and others have been the re- 
sources which the ingenuity of surgeons at dif- 
ferent times has brought forward ; but the ulti- 
mate result of all these has only been of tem- 
porary or partial benefit, some deformity of lid 
and ball still remaining, or an entire failure, 
the cicatrix too often growing more tense and 



October 27, I860.] 



COMMUNICATIONS. 



85 



rigid, with increase of deformity, by tlie re- 
peated sections. 

As cicatrices, wherever situated, are formed 
by nature after destruction of the dermis and 
cellular tissue as a protecting shield for the 
subjacent parts, and being made up of an ad- 
ventitious tissue,having a high degree of density, 
and, as such, an inherent tendency to contract 
upon itself, they generally are not capable of 
being elongated ; nor will incisions, cauteriza- 
tion, etc., modify their structures so as to yield to 
permanent extension. Speedy reunion follows 
these attempts at separation, the original tissue 
acquiring a greater density and increased prone- 
ness to contraction. No permanent relief, there- 
fore, can be expected from sections of an exten- 
sive and firm cicatrix agglutinating the lids to 
the eye, as it will be reproduced with increased 
density of its tissues, the neigboring conjunc- 
tiva not being able to assist in relieving the de- 
formity by its elasticity, as we at times see the 
dermis accommodate itself by elongation in 
remedying contractions of different parts of the 
body. Excision of the cicatrix alone promises 
success, but not if unaided by eversion of the 
lids during the progress of cicatrization. To 
effect proper eversion of the effected lid, how- 
ever, and to maintain it for several weeks, till 
the wound, after excision, has healed, is of the 
greatest importance. With this point in view, 
plaster strips have been applied, confining the 
tarsus to the cheek or forehead, the outer can- 
thus has been cut into downwards, the lid everted 
and kept in this position by plaster strips, or an 
ansa, to the face. The inconvenience, however, 
which the protracted eversion of the lids entails 
upon the uncovered eye, irritated by exposure to 
the air, is generally too much complained of by 
the patient. To guard against these and simi- 
lar objections, but acting upon the principle that 
the ball of the eye must be prevented from 
coming into contact with the lids till its wounded 
surface, made by excision of the cicatrix, is per- 
fectly cicatrized, we have pursued a plan (may 
it be called novel ?) which has accomplished 
the object in view, without incommoding or ex- 
posing the eye during the process of cicatriza- 
tion — nay, even leaving it to the full enjoy- 
ment of all its functions. 

The history of the following case will best ex- 
plain the mode of proceeding and its happy re- 
sult : — 

Albert Gerlach, iron-worker, 30 years of age, 
of Pittsburgh, in passing through the mill in 
which he was employed, was struck by a hot 



cinder, from a pile on which water had been 
thrown, into the right eye, burning the outer 




part of the ball and eyelids severely. Great 
tumefaction of the lids and suffering were the 
consequence. Cicatrization was slow, with de- 
formity resulting. Two years after, the eye was 
still impeded in its motion and bound down to 
the outer canthus, to the upper and lower lid 
by firm and strong adhesions, producing stra- 
bismus divergens, while the cicatrix extended 
over the cornea to near its centre, the outer half 
of the lids being drawn upwards and down- 
wards, unduly exposing the eyeball to the con- 
tact of the air and irritating it by extension. 
After several attempts had been made by in- 
cision, excision, and cauterization, with the 
usual results, failure and increase of deformity, 
I was called upon for relief. 

January 12, 1858. Having administered 
ether, I made a semilunar incision along the 
rim of the orbit, above and below the outer 
canthus, through the skin down to the bone, to 
the extent of more than an inch, while the eye- 
lids were held closed in their natural position. 
The canthus externus next being lifted up by a 
blunt hook, the upper and lower lids were cau- 
tiously separated from the cicatrix, and the dis- 
section continued until the knife had passed 
through, meeting the elliptical incision over the 
rim of the orbit. A slit thus being made, the 
lids were freed from the ball of the eye above 
and below the original cicatrix, which was then 
carefully excised from the eye. After the bleed- 
ing had been arrested, a fine pledget of muslin, 
well oiled, wide enough to fill up the slit in the 
skin, and a few inches long, was passed through 
the cut between the lids and the ball of the eye, 
emerging at the outer commissure of the eyelids 
and tied over a convex, narrow, silver plate, 
resting with its flattened extremities upon the 
OS frontis and malse over the outer canthus 
of the eye. Thus the outer parts of the lids 
were well kept elevated from the eye, allowing 
it undisturbed freedom, yet guarding it from 
exposure, the eyelids still being the natural pro- 
tectors. At first, cold water dressings were ap- 



86 



COMMUNICATIONS— HOSPITAL PEACTICE. 



Vol. V. No. 4. 



plied, which, after a few days, were exchanged 
for laudanum and lead-water lotion, the wound 
being syringed several times a day, with tepid 
chamomile infusion. The patient was not re- 
stricted in his habits. 

The separation and elevation of the lids was 
thus kept up for three weeks, the only dressing 
needed being the occasional change of the mus- 
lin slip which had acted as an elevator of the 
lids. At the expiration of that time, complete 
cicatrization of the wound of the eye having 
taken place, the elevator was removed from 
the slit in the lids, which were now allowed to 
drop down to their natural position. The in- 
cision over the orbit, too, being cicatrized, its 
edges were next freshened and united by fine 
Carlsbad needles. Union by first intention fol- 
lowed, no trace of deformity remaining, the line 
of incision along the rim of the orbit exterior 
to the canthus only being perceptible. 




A result so satisfactorily and readily obtained 
commends itself to the attention of the surgeon. 
Adhesions, too, affecting the upper and lower 
eyelids in the middle, and the corresponding 
portion of the eyeball, may be freed by similar 
incisions through the skin along the upper and 
lower margin of the orbit, with subsequent tem- 
porary elevation of the lids from the globe of 
the eye. The cicatrix, if not extensive or cal- 
lous, and not interfering with vision, need not 
be excised — incision through it beyond its 
boundaries into the line of reflection of the 
conjunctiva being sufiicient. There can be no 
failure of success if the exterior wound is kept 
open by the interposition of the pledget until 
the cicatrix of the globe and eyelid has healed. 



Syphilitic Sore Throat. — As a local application 
in syphilitic ulceration of the throat, tongue, 
and lips, Mr. Coulson, of St. Mary's Hospital, 
makes use of the following formula with great 
success : — Bichlorid. hyd., grs. vi. ; hydroch- 
loric acid, 12 drops ; syrup, 1 ounce ; water, 8 
ounces ; to be used three times daily as a gar- 
gle, and the mouth to be washed after using it. 



Illtrsttfltinns til Inspiial frartirh 

PENNSYLVANIA HOSPITAL, 

Service of Dr. J. Forsyth Meigs. 
SEPTICiEMIA FOLLOWING RHEUMATISM. 

A sailor, 26 years of age, entered the hospi- 
tal June 30, having a few days before been at- 
tacked with pain in the joints and extremities. 
When Dr. Meigs took charge of him he had a 
severe attack of articular rheumatism. All 
his joints were swollen, but there was no car- , , 
diac complication. He was treated with nitrate 
of potassa and Dover's powder, and appeared 
to be doing very well. 

But when he was just expected to become ra- 
pidly convalescent, he became suddenly worse, 
and sank into a fever of a low type, accom- 
panied with some secondary pneumonia and 
bronchitis. He was sick for many days. 

But although his general condition was such 
as might have led to the assumption that he 
was suffering under typhoid fever, close exami- 
nation of the case must lead us to a different 
view. He had no rose-colored eruption, no 
diarrhoea, no marked tympanitis, no tenderness 
in the iliac fossa. We incline hence to consi- 
der the case one of pyemia, or septicsemia — the 
pycemia following rheumatism, of Bennett, of which 
that author has given some very instructive 
clinical observations in his lectures on clinical 
medicine. Another point which strengthens 
this view of the case is, that the patient was 
occasianally attacked with chills and rigors. 

But although this affection is called pyeemia, 
it must be remembered that it is really not cha- 
racterized by the presence of pus in the blood, 
but that it is owing to the introduction or forma- 
tion of some animal poison with the nature of 
which we are unacquainted ; hence the term 
septicaemia is preferable to pysemia. 

The condition of the system to which this 
name has been applied, has been observed to 
be owing to various causes. As already stated, 
and as the case before us is an instance, it fol- 
lows acute rheumatism ; dissecting wounds 
cause it, and Vogel, the excellent Oerman pa- 
thologist, mentions the case of a man who was 
attacked with septicaemia as the result of violent 
dancing through a whole night. 

Perhaps we may trace the origin of the dis- 
ease in the case before us by tracing the attack 
to its commencement. As already stated, he 
was convalescent, and was ordered to be watch- 
ed carefully, in reference to sitting uj^ or taking 
exercise. He was seen in the forenoon, when 
his pulse was perfectly natural. In the after- 
noon, instead of sitting up but for a little while, ! 
as had been recommended, he not only sat up, ) 
but also walked around the ward for about two 
hours. When he was seen the next morning 
his pulse was 156 in a minute, and from that ' 



October 27, 1860. 



HOSPITAL PEACTICE. 



87 



time dated his long, lingering illness, so closely 
resembling, in many respects, typhoid fever. 

Now there can scarcely be a doubt that ex- 
ercise under these circumstances induced the at- 
tack. But how is it produced? Is it simply 
the reaction of the exhausted nerves ? We can- 
not say positively ; yet it seems as if there was 
something else beside mere nervous exhaustion. 
In the British reports, Mr. , and Carpen- 
ter, the well known physiologist, endeavor to 
explain the fact why zymotic diseases, like 
cholera, small-pox, etc., attack more readil}', at 
the beginning of an epidemic, the hard-laboring 
classes; and they conclude that this tendency 
is caused by the greater muscular activity in 
the laboring classes, causing a much more ra- 
pid destruction of tissues, and hence rendering 
the secondary assimilation more energetic. 
With a large amount of disintegrating tissues 
thus present in the system, any morbific in- 
fluence or agent finds a good nidus in which to 
act. 

Now we can readily conceive how in a patient 
who has undergone a long sickness, and is just 
convalescing, too much muscular exercise may 
cause a more rapid disintegration of tissues and 
secondary metamorphosis, than the enfeebled 
functions can take care of, or the weakened 
state of the system can bear; a mass of efete 
material thus accumulates and the state of the 
blood is so altered that we have the patient fall 
into this low condition which characterizes 
septicaemia. Even in the perfectly healthy, 
excessive muscular exercise may bring on the 
septicaemic condition, as in the case mentioned 
by Vogel. 



UNIVEESITY OF PENNSYLVANIA. 

MEDICAL DEPARTMENT. 

(Service of Prof. Pepper.) 

VALVULAR DISEASE OF THE HEART. 

The patient is a boy sixteen years of age, of 
healthy appearance, and fairly developed for 
his age, who worked on a farm. During the 
last six months, he complains of tightness in 
his chest ; some difficulty of respiration ; there 
is no fever ; but he states that for some time 
past he has observed his feet to be swelled 
occasionally, when putting on his boots. 

On questioning him closely, it does not appear 
that he was ever attacked with acute rheuma- 
tism ; but he states that, about a year ago, he 
had pain in his legs and joints, which, however, 
did not prevent him from working as usual. 

Present Condition. — His pulse is rather feeble, 
easily compressible, not intermittent. It is 
evident that there is some slight obstruction to 
the circulation, probably in consequence of some 
difficulty of the heart. 



Physical Examination. — On inspecting the chest, 
there is found to be a slightly increased impulse 
externally. A well-marked double bellows- 
sound is heard over the apex of the heart, but 
not above. The bellows-sound is strong, almost 
amounting to a saw sound. Now, there might be 
a question whether this abnormal sound is not 
produced by anaemia. But if you look at the pa- 
tient, his florid complexion, his active capillary 
circulation, at once negative such a theory, and 
there remains no doubt that the patient is suf- 
fering from disease of the mitral valve, in con- 
sequence of morbid thickening and deposits on 
the valves, caused by rheumatism ; for though 
it does not appear that he had an acute attack 
of this disease, the pain in his joints and limbs, 
which he states to have had about a year ago, 
probably was of a rheumatic character. 

This is an interesting case of latent cardiac 
disease. Ninety cases out of a hundred of 
cardiac disease in the young are the result of 
acute rheumatism, from endo-pericarditis. In 
this case there is no friction-sound, indicating 
the former existence of pericarditis. The sound 
is entirely endo-cardiac. Valvular disease, as the 
result of rheumatism, very rarely attacks the 
right side of the heart, but generally the left, 
and most frequently the mitral valves. 

The rheumatic diathesis may attack the car" 
diac structure, though there may have been no 
articular disease ; and we must be careful not 
to throw out the probability of the rheumatic 
origin of valvular disease, simply because the 
patient may not have had an acute attack. 
There is no reason why the cardiac structures 
should not be attacked at the exclusion of the 
joints. 

Prognosis. — In the vast majority of cases of 
valvular disease in the young, resulting from 
rheumatism, the patients get well. I have seen 
well-marked mitral afifection entirely removed 
in the course of a year or two. The prognosis 
in this case is hence not so very unfavorable, 
on account of the youth of the patient. But 
when the disease occurs after twenty-five or 
thirty years, the fatality is much greater. 

As far as the general symptoms are concerned, 
these rheumatic aftections of the heart are 
sometimes entirely latent. 

The treatment consists essentially in rest ; the 
avoidance of anything that excites the circula- 
tion or the system generally. The patient 
should quit his work on the farm ; and, if at 
work at all, it should be light. He should be 
warmly clad, and care be taken not to expose 
him to the causes which favor attacks of rheu- 
matism ; the exercise which he takes should be 
gentle, and not active. Permanent counter- 
irritation to the chest, and Lugoll's solution 
internally, three drops three times a day, v/ould 
be the therapeutic means to be recommended in 
his case, while his diet is to be of a nutritious, 
but bland, unstimulating character. 



88 



HOSPITAL PEACTICE— MEDICAL SOCIETIES. 



Vol. V. Xo. 4. 



JEFFEESON MEDICAL COLLEGE. 

Service ot Prof. Gross. 

[Reported by N. G. Blalock, of N. C] 

CAPSULO-LENTICULAR CATARACT OF THE LEFT EYE. 

Mrs. M., aged 50 years, with good general 
health, has been suffering from cataract for six 
years. It came on slowly at first, and without 
any assignable cause, and it is now complete. 
She can, however, see a little after sun-set, or 
before it rises ; much better, at least, than by 
bright sun-light. From the appearance of the 
cataract. Dr. Gross believed it to be of the 
capsulo-lenticular variety, in which both the 
capsule and the lens are involved. The only 
cure for this disease is an operation, and this 
being a favorable case, the operation of extrac- 
tion was performed, it being preferable on ac- 
count of its long standing and hardness. The 
patient was placed in a chair, and an assistant, 
standing behind her, steadied the head, and 
also controled the upper eye-lid. Professor 
Gross sat immediately before the patient. With 
a Beer's cataract knife, he made the upward 
section of the cornea, about one-third of its 
circumference being included in the flap. Gen- 
tle pressure, made with the handle of the knife 
on the lower segment of the eyeball, caused the 
lens to be displaced without the slightest diffi- 
culty. The lids of both eyes were then closed, 
with strips of isinglass plaster, and the patient 
was placed in a dark room. She was ordered 
the fourth of a grain of morphia, and to be 
placed upon a very light, unstimulating diet. 

CONGENITAL CLUB-FOOT. 

The patient was a child, six months old, of 
good general health, and who has been suffer- 
ing with equino-varus since its birth. The 
fault was mainly in the tendo-Achillis, to re- 
lieve which the tendon was divided, a short 
distance above its attachment to the calcaneum, 
by passing a delicate tenotome through the skin 
and in front of the tendon, and then turnino- 
the cutting edge toward the surface. By a 
sawing motion, the tendon was divided with an 
audible snap, leaving a gap between the divided 
ends, which will soon fill up with plastic ma- 
terial. The foot could now be put in its nor- 
mal position. The patient needs but little treat- 
ment for three or four days, then we will apply 
an apparatus. The operation was attended 
with the loss of scarcely a drop of blood, and 
gave but little pain. 

CONGENITAL MOLE. 

Miss S., sixteen years of age, was brought to 
the clinic on account of a mole, which had ex- 
isted since her birth, and which occupied a 



space of about two square inches over the right 
molar and body of the superior maxillary 
bones, and also extended a short distance above 
the outer canthus of the eye, involving the 
outer third of both lids. The integument, con- 
stituting this growth, was of a dark-brown 
color, it had a verrucous appearance, and was 
covered with short, crisp hairs. To relieve the 
deformity, the patient being under the influence 
of ether. Professor Gross made a very careful 
dissection of the mole from its cellular attach- 
ments, and upon bringing the edges of the 
wound together, the amount of tension was 
found to be so great, that another incision was 
made at the edge of the hairy scalp, the bridge 
of skin being separated from the deeper parts. 
This allowed of the most perfect apposition of 
both wounds, except a very small triangular 
space at the lower portion, and several points 
of the interrupted suture were used to bring the 
cut and surfaces together. Cold water dress- 
ings were ordered to be applied to the parts, 
and her bowels were to be kept in a soluble 
condition, and her diet should be light and un- 
stimulating. 



PHILADELPHIA COUNTY MEDICAL 
SOCIETY. 

(Reported by Wm. B. Atkinson, M. D., Recording Secretary.) 

Wednesday Evening, October 10th. 
Dr. Isaac Eemington, President. 
Subject for Discussion : Opium as a Therapeutic 
Agent. 

(Continued from page 65.) 

In the treatment of idiopathic fevers, opium 
has been much employed in fulfilling various 
indications, and under different and even oppo- 
site states of the system. As an effective agent 
in preventing the chill of intermittent fever its 
power has long been known. When given a 
short time before the expected period of return, 
and aided by warm drink, it has generally suc- 
ceeded in preventing the chill, or, at least, has 
rendered it shorter and less severe. Its mode 
of operation in these cases seems to consist in 
allaying, or rather in forestalling, peripheral 
irritation, thus maintaining the norinal circula- 
tion of the blood and consequent determination 
to the surface. In certain peculiar conditions 
of the system, arising during the progress of 
continued fevers, opium is much employed. 
These conditions are among the most usual that 
demand our attention in the course of typhus 
or typhoid fevers, and also in the progress of 
symptomatic fevers. Of typhus I have scarcely 
any knowledge, having seen but few cases of 



October 27, 1860. 



MEDICAL SOCIETIES. 



89 



the disease. Generally speaking, toward the 
end of the second, or during the third and 
fourth weeks of the existence of typhoid fever, 
we have presented to our notice the condition of 
the system just alluded to. The more active 
period of the disease having passed, the patient 
is now left prostrate, and daily shows a ten- 
dency to a still further depression of the vital 
forces. This is clearly indicated to one who 
has seen much of this fever (and especially in 
the more violent character it generally as- 
sumes in suburban or rural districts) in the 
very ^^ Fades Morbi." The expression of counte- 
nance at once indicates great debility, combined 
with an indescribable malaise ; the surface is 
generally dry, and often hot ; the respiration 
quick and uneasy; the pulse irritated; the tongue 
most frequently dry, red, chopped, or very 
smooth, with or without coating ; sordes are 
often noticed upon the teeth ; the intellect con- 
fused during some part of the day or, more 
commonly, the night; delirium and rambling, or 
a strong tendency thereto, exists ; yet the patient 
generally answers well enough when spoken to. 
With this train of symptoms he is unable to 
sleep, unless in short and uneasy spells. Such 
is the condition alluded to, at least in its more 
striking features. Independent of the primary 
cause of the disease, no circumstance so tends 
to keep up this condition as the want of sleep, 
and until this be obtained the prospect of 
amendment is remote. Notwithstanding the 
heat of surface, irritated and sometimes rather 
hard, though small pulse, redness of the tongue 
and flushed face, the state of the system is es- 
sentially asthenic. 

There is, in such cases, scarcely any call for 
food, though, when offered, it may be taken, as 
it were, automatically. Complete derangement 
in the harmony of the cerebro-spinal and sym- 
pathetic systems seems to exist. The constant 
wakefulness and incessant exercise of the intel- 
lectual faculties often upon perplexing topics 
of business, robs, as it were, the organic system of 
its due share of blood and nervous influence, and 
thereby impairs more and more the organs destined to 
nutrition and the maintenance of the vital powers. 
So long then as the intellectual powers remain 
in an excited and abnormal condition no im- 
provement need be hoped for. Here it is that 
opium often displays its highest powers in the 
removal, as well as in the alleviation of disease, 
and the benefit that often accrues to the patient 
in such circumstances, from one or two nights 
passed in sleep, has surprised those who wit- 
nessed it. The improvement is at once seen in 
the more animated countenance, the fuller and 
slower pulse, softened or moist skin, and dimin- 
ished heat of surface ; and, notwithstanding the 
generally depressing effect of opium upon the 
digestive organs, there is, under this altered 
condition, an improvement of the appetite. To 
what special influence of opium, in the case be- 
fore us, the change is to be attributed is per- 
haps not fully determined. In view, however, 



of its widely-extended power over the nervous 
system, and in the opinion that such a condition, 
as just described, cannot exist, independent of a 
total want of harmony in the correlative movements of 
the nervous centres, we are perhaps justified in 
saying, that the especial object accomplished 
by our remedy is the harmonizing these per- 
verted movements. The beneficial action of the 
medicine is derived, perhaps, both from its 
stimulant and sedative qualities. For, as it is 
difficult to conceive of such perverted action, 
without excess of movement in one system or 
in one organ, as compared with another, so is 
it difficult to account for the controling and 
harmonizing influence of opium, without sup- 
posing it to exert a combined stimulant and se- 
dative action. Yet, it is not probable that any 
such contrariety of effect should occur as the 
direct and immediate action of the remedy, but 
in an indirect, collateral way, as we see an in- 
stance of in case of intense spasmodic pain 
from the passage of biliary or urinary calculi, 
where the almost suppressed action of the heart 
and arteries is restored through the action of 
opium in relieving this painful spasm. 

This part of the subject has been dwelt longer 
upon, because the state alluded to is of frequent 
occurrence, not only in idiopathic fevers, but in 
advanced stages of many inflammatory affec- 
tions ; and in all such cases the same line of 
treatment becomes necessary. Small pox is 
another disease in which the utility of opium is 
strikingly shown. So long as the patient bears 
up well under the attack, it seems most pru- 
dent to avoid its use, and thus also husband our 
resource. But it often happens that, as the pus- 
tules approach maturation, irritation of the 
nervoas and vascular systems is greatly in- 
creased, and about the same time the patient is 
harrassed with a tenacious phlegm, exceedingly 
difficult to detach from the throat and fauces. 
In these cases opium exerts a most salutary 
effect in relieving these symptoms, and procur- 
ing quietude and sleep. Eheumatism, no 
matter how acute the attending fever, or how 
robust the patient may be, will, after venesec- 
tion or, perhaps, without, be found more amena- 
ble to the influence of opium or Dover's powder, 
alone, or combined with antimony, than to 
most other measures. If the pain be intense, 
so will be the nervous irritation ; and in such 
cases the doses should be large enough to sub- 
due the pain and quiet irritation, and as this is 
one of those diseases in which the system sup- 
ports very well the action of the medicine with- 
out inconvenience, it should be freely employed. 

In puerperal peritonitis we have another in- 
stance in which opium displays the most ad- 
mirable powers, curative as well as anodyne. 
The inflammation in this case seems to assume 
a peculiar type, depending in all probability 
upon the unusual condition of the patient at the 
time of attack, and also upon the (as it were 
abnormal) state of the parts implicated. The 
woman at the time is comparatively debili- 



90 



MEDICAL SOCIETIES. 



Vol. V. No. 4. 



tated, the result of various agencies active 
during labor and subsequent thereto. Grene- 
rally a considerable, often a great, loss of blood 
has occurred, and if the labor has been very 
severe and protracted, the debility has been 
further increased by the inordinate expenditure 
of nerve power. In addition, not much food is 
apt to be used during labor, and low diet is en- 
joined upon the patient afterwards. With this 
condition of body in view, and bearing in mind 
the peculiar state of the uterus and adjacent 
parts, and the facility and rapidity with which 
gangrene, or a near approach to this condition, 
may supervene, we cannot be too careful to 
adopt such treatment as will least prostrate the 
strength that remains. Peritonitis, in my own 
practice, has generally followed severe and pro- 
tracted first confinements. The sheet anchor, 
as it is termed, is, in such cases, opium, or 
Dover's powder, given freely and especially 
early in the attack, with the object of forestalling its 
further development. The action of the opium 
may, in a few cases, where the patient is very 
plethoric, be assisted by a use of the lancet ; as 
a rule, this should be sedulously avoided. 

Of the almost endless variety of medicines re- 
sorted to for the cure of dysentery, no one pos- 
sesses the same power to alleviate the suffering 
and expedite a recovery as opium. That much 
discrepancy of opinion on this point has exist- 
ed, and continues to exist, we are well aware. 
Whilst some have thought the employment of 
this remedy should be confined to mild attacks, 
(thinking these were the only cases to be bene- 
fited by its use,) accompanied with but slight 
febrile movement, others have found especial 
advantage from its action in the most violent 
epidemic form of the disease. My own some- 
what extensive experience in this disease has 
not shown the necessity of any distinction of 
this kind, the good efi'ects of the medicine being 
manifest in either case. In the more violent 
forms, occurring sporadically, or as an epide- 
mic, opium unquestionably has its position in 
the first rank of medicines, capable of allevia- 
ting and curing this most painful, harrassing, 
and dangerous malady. Excessive febrile move- 
ment, great tenderness of the abdomen, severe 
griping pains, with oft-repeated bloody stools, 
violent and most distressing tenesmus, exces- 
sive nervous irritation, with more or less deli- 
rium on the prominent manifestations of the 
disease, as it more especially shows itself in 
rural districts. To successfully combat such a 
train of symptoms, after attending to the re- 
moval of the fecal contents of the bowels, the 
indications are evidently to abate, as far as pos- 
sible, the force of febrile action and to allay the 
excessive pain and irritation, local as well as 
general. The loss of blood, by bleeding from 
the arm, or leeches to the abdomen, may often, 
with marked advantage, precede the employ- 
ment of opium, and render the operation of this 
remedy more manifest; yet, as a general rule, 
bleeding needs not to be repeated. As the 



arterial excitement is chiefly "kept up hy the intense 
pain and excessive nervous irritation, the anodyne 
and sedative power of opium is most to be de- 
pended upon for the removal of these symptoms, 
and when properly employed, in reference to 
amount, time, and the peculiarities of each 
case, no other article of the materia medica can 
favorably compare with this agent. The ad- 
vantages obtained by such use of opium are 
often promptly manifested, but in many other 
cases it is necessary to keep the patient under 
a guarded use of the medicine for a length of 
time, the stubborness of the disease, in its 
strongly-marked epidemic form, being well 
known. Yet, with all the power exerted by 
opium in controlling this disease, there must be 
many failures in the epidemic variety, and 
hence, perhaps, the doubt of its utility in these 
difficult cases, on the part of some physicians, 
who unfortunately have hitherto furnished noth- 
ing more promising as a substitute. The solution 
of the disease is generally by the production of 
perspiration, and the return of the various func- 
tions to their normal state, apparently the se- 
quence of subdued pain and nervous irritation, 
and these are often removed more quickly and 
effectually by repeated injections of laudanum 
and starch than when the medicine is received 
into the stomach. 

In simple cases of diarrhoea, the product of 
suppressed perspiration, or of intestinal irrita- 
tion from ordinary causes, as undigested food, 
and not connected with organic disease, we 
have in opium the readiest and surest remedy. 
The same may be said of cholera morbus, as 
we see it every season, and here advantage is 
generally derived by combining the opium with 
camphor. In the treatment of Asiatic cholera 
I have had but a limited experience, and this 
was not in favor of opiates. When the disease 
is fully developed in its congestive form, we could 
scarcely think of deriving benefit by the em- 
ployment of opium. 

In the different inflammatory affections of the 
respiratory apparatus, opium is exceedingly use- 
ful. It has been attempted, by some writers, to 
show that the remedy is more especially appli- 
cable to inflammation of the mucous membrane 
of the air passages and of the parenchymatous 
structure of the lungs. This restriction, how- 
ever, can hardly be thought well founded, as 
the serous membranes of the chest, when in- 
flamed, are, in common with the adjacent tis- 
sues, amenable to the same beneficial action exer- 
cised by opium upon inflamed tissues in general. The 
greater advantage that may seem to arise from 
its use in one, rather than in the other case, is, 
perhaps, not so much from difference of tissue 
as from diff'erence of function in the parts con- 
cerned. The quieting of cough, so much more 
common when the mucous surfaces are affected, 
and the production of expectoration when opium 
is combined (as is usual) with antimony or ipe- 
cacuanha, may, perhaps, be more properly re- 
garded as adventitious benefits in the action of 



October 27, 1860. 



MEDICAL SOCIETIES. 



91 



the remedy. The action of opium in this, as 
in inflammation generally, seems to consist in 
one general influence, that of equalizing or har- 
monizing the distribution of nervous power j thus 
removing irritation, and thereby restoring the 
lost balance of the circulation, or (if this phrase, 
as some have thought, be objectionable) in re- 
storing the movement of the capillary system to its 
normal condition. The immediate efl'ect of this 
return of the capillary system to a normal state, 
is the restoration of the normal action of the various 
organs, and consequently the return of the natu- 
ral secretions, and hence the resolution of in- 
flammation by perspiration, abundant mucous 
or muco-purulent secretion, increased flow of 
urine, &c. Of the great number of diseases and 
deviations from the healthy state to which the 
economy is exposed, few are more benefited by 
the use of opium than are some of those pecu- 
liar to females. For the prevention of threat- 
ened abortion, opium, when quietude is ob- 
served, is the most efl^^ectual of all remedial 
agents. This holds good whether the exciting 
cause be from within or without, and it is more 
especially useful to women of nervous tempera- 
ment and irritable fibre. 

In haemorrhage, coming on either before or 
after abortion, and at or near full term, it is 
likewise, of medicinal substances, the most re- 
liable ; and it has been proposed by some prac- 
titioners to administer the medicine, if the case 
be alarming, nearly to the production of nar- 
cotism, if a less effect does not suflice. Such 
a condition, however, or any approach to it, is 
to be avoided, and can rarely, if ever, be re- 
quired. The mode of operation of the medi- 
cine in these cases, is of diflicult solution. With 
the twofold object in view of relieving pain and 
facilitating the expulsion of the ovum in una- 
voidable abortion, opium, when freely given, is 
often productive of the best effects, as it fre- 
quently happens, that, whilst the pain (some- 
times of an excruciating character) is dimi- 
nished, the rigidity of the os uteri gives way, and 
the conception is cast off. In misplaced pain, 
during parturition, opium will sometimes act 
very beneficially. A strongly marked case of 
this kind occurs to me of a young woman at- 
tended during my stay in the country. Shortly 
after the commencement of labor, with natural 
and properly located pains, she was attacked 
with pain of an almost unendurable severity, 
.affecting and extending from the fundus of the 
uterus deeply into the left hypochondrium. 
Having obtained scarcely any relief from two 
or three full doses of morphium, and having suf- 
fered in this way during nearly three hours, a 
consultation was requested. The consulting 
physician proposed a greatly increased dose, 
and, in forty or fifty minutes after taking it, the 
patient was entirely relieved of the misplaced 
pain, and this was soon followed by the re- 
establishment of natural labor. Where, in la- 
bor otherwise natural, the rigidity of the os uteri 
is excessive, or where the difficulty seems to 



consist in irregular action of the nerves and 
muscular tissue of the uterus, the good effects 
of opium in harmonizing the spinal and gang- 
lionic nervous influence, is sometimes seen in 
diminished pain and shortened labor, as in the 
case of abortions before alluded to. 

As before intimated, it was not my design in 
this introduction to do anything more than to 
notice some of the more prominent diseases and 
conditions of the system in which opium was 
employed. To attempt more than this, would 
be in a measure to traverse nearly the whole 
field of medical theory and practice, and I shall 
therefore bring this paper to a close in a few 
general observations. The employment of opium 
in medicine, and especially in full and repeated 
doses, has been objected to, as before said, by 
some writers, as fraught with too much danger 
for ordinary use. This objection may with 
equal propriety be urged against nearly all the 
more potent articles of the materia medica, and 
as regards many with much more reason. It 
is doubtful if there be a single drug, or pre- 
paration of pharmacy, capable of fulfilling, 
in a satisfactory manner, a tithe of the in- 
dications so well performed by this agent, 
whose employment is not attended with more 
risk if rashly used. Some of these are slow 
in manifesting their immediate action or their 
ulterior effects, and yet, when accumulated 
in the system to a certain extent, exhibit their 
power, at times, in an extraordinary and un- 
manageable form. Others produce irritation of 
the mucous membranes, or other tissues, and in- 
sidiously establish sub-acute inflammation and 
consequent perverted organic action and ill 
health. With a proper degree of caution, none of 
these disagreeable consequences are seen to fol- 
low the use of opium. Its action is frank and un- 
disguised, and so soon as we perceive a tendency 
to excess in its operation, we have but to sus- 
pend, for a time, its further use, and the un- 
pleasant symptoms gradually disappear without 
any permanent ill consequences remaining. Let 
me not, in making these remarks, be misunder- 
stood, for, as previously stated, the successful 
employment of opium requires the nicest patho- 
logical discrimination and close attention to its 
effects, and where the indications for its use are 
not clear, redoubled caution, or non-employ- 
ment of the medicine for a time, would seem to 
be the proper course. 

One of the most singular effects of opium is 
seen, as before hinted, in its apparent contrariety 
of action, as we may see, for example, when 
given in certain anaemic states unattended with 
fever. Here it will often remove a disposition 
to sleep, acting apparently as a stimulus to the 
brain, by inducing a greater degree of arterial 
action or a degree of congestion in its vessels. 
We have instances of this sort in diseases of a 
slow, wasting character, where nutrition, and, 
as a sequence, sanguification, are badly per- 
formed, and sometimes after great loss of blood 
or other discharges. 



92 



MEDICAL SOCIETIES. 



Vol. V. No. 4. 



In the same ansemic state with irritation and 
fever, opium will often procure sleep, acting in 
this instance by allaying nervous irritation from 
its sedative power, and inducing sleep by its 
anodyne and soporific qualities. Instances ot 
this sort are seen in the latter stages of typhus 
and typhoid fevers, in typhoid pneumonia, in 
many other analogous conditions, and, strangely 
enough, sometimes in the reactionary fever 
noticed after excessive haemorrhage, as in some 
cases of abortion. In the removal of a disposi- 
tion to sleep in anemia without fever, by as- 
suming the recumbent posture, and in its pro- 
duction in plethoric states of the system from 
the same recumbent position, we have some- 
what similar phenomena. Again, opium, in 
moderate doses, invigorates the action of the 
heart in anaemia without fever, probably by a 
direct action. It likewise invigorates the action 
of the heart when nearly suppressed, as before 
alluded to, in the excruciating pain caused by 
the passage of biliary or nephritic calculi, or 
violent cramp of the stomach and bowels, and 
in these cases the action upon the heart seems 
indirect. The various phenomena in the move- 
ments of the heart and arterial system, under 
the action of opium, are matters that merit the 
closest observation of the physician, not so much 
as mere objects of curious physiological inquiry, 
as with a view to the deduction of some useful 
theory, from which may be educed principles 
and rules of practical utility in medicine. The 
physiologist has experimented much in refer- 
ence to the influences controlling the move- 
ments of the heart, and the various agents by 
which these movements may be modified, but 
with only partial success : for whilst he has, to 
a considerable degree, determined the influence 
of each separate branch upon the nervous system 
upon its movement, their correlative influences 
yet remain in obscurity. Let it be the object of 
the practitioner, at the bedside of his patient, 
by the most rigid and patient scrutiny, to secure, 
for the benefit of the "Healing Art," as large a 
share as possible of that knowledge, which the 
knife of the exclusive pathologist and vivi-sec- 
tionist has, with all their commendable efforts, 
failed to supply. In conclusion, I would say 
that a want of sufficient time has in part pre- 
vented me from presenting a paper more in ac- 
cordance with the importance of the subject 
treated. 

{Discussion next week.) 



ACADEMY OF NATURAL SCIENCES. 

Meeting of October 16th. 

Dr. Bridges, Vice President in the Chair. 

Various donations to the Museum and Library 
were presented. 

Letters were read from the Society of Arts 
and Sciences at Utrecht, Holland, F. A. Sau- 
valle, of Havana, and Prof. S. S. Haldeman. 



The following papers by Charles C. Abbott 
were presented for publication in the Proceed- 
ings : — "Descriptions of new species of apodal 
fishes in the Museum of the Academy of Natural 
Sciences ;" "descriptions of two new species of 
galeichthys from Kansas;" "descriptions of 
four new species of North American cyprinid ;" 
a "description of a new species of exocetus from 
Chili ;" which were referred to a committee. 

Dr. Leidy exhibited a portion of the upper 
jaw of an extinct species of dicotyles or peccary, 
which he had recently received from Dr. Owen, 
of New Harmony, Ind., which he compared 
with the skull of the extinct species belonging 
to the collection of the Philosophical Society, 
and which was found about fifty years since. 
He decided that it belonged to a different species 
from it, and also pointed out the differences 
between it and the two species now existing. 
He did not propose to give any name to the 
species at present. 

Dr. S. Weir Mitchell made a very interesting 
communication on the subject of the poison of 
the rattlesnake. After adverting to the history 
of the various works on venomous reptiles, he 
proceeded to explain the anatomy and physi- 
ology of the poison apparatus of the rattlesnake. 
He showed first, by the aid of magnified draw- 
ings of the parts, the bon}^ structure of the jaw, 
and the manner the various parts were articu- 
lated together, so as to keep the poison fang in 
such a position, when not required for use, as 
not to interfere with the feeding of the snake, 
and then the manner in which it was pushed 
forward and brought into the position most 
favorable for striking with effect. He then 
explained the action of the various muscles by 
which the fang was drawn back and thrust 
forward, and showed how one of these, while 
erecting and fixing the fang, at the same time, 
as soon as it had pierced the animal bitten, 
compressed the poison gland and forced the 
poison out, either through the duct leading 
through the tooth to the bottom of the wound, 
or beside it, and into the surface of the same. 
He then explained the position of the poison 
gland and its duct, and showed the manner in 
which this duct communicated with the one 
leading through the tooth, and the manner in 
which the poison was prevented from flowing 
out when the fang was not erected. "When the 
fangs are torn away, they are soon replaced by 
others; indeed they appear to be regularly shed 
by the animal, so that it gives no security 
against a fatal bite that the fangs have been 
removed. 

The poison is contained in the poison gland 
in considerable quantity, as much as ten to 
fourteen drops having been procured from a 
single one from a snake about four feet long. 
It is of a pale greenish yellow color, and its 
activity is not impaired by keeping for years. 
It may be swallowed, if the skin of the mouth 



October 27, 1860. 



PERISCOPE. 



93 



and throat be not broken, with impunity. Its 
poisonous properties are not destroyed by boiling 
or freezing. After it bas been dried, it may 
be again restored to all its virulence iDy again 
dissolving it in water. There appears to be no 
absolute antidote to it. The most successful 
plan is to give some powerful stimulant, such 
as spirits or ammonia. When spirits are given, 
it is necessary to keep up the stimulation fully 
for a considerable time. The quantity some- 
times taken, without producing intoxication, is 
very great ; in one case specified, three pints of 
strong spirits were given. The Doctor remarked, 
however, that at one of our military posts, it 
was very common for the men to be bitten by 
rattlesnakes so long as the whisky cure was 
used; but when a different and nauseous stimu- 
lant was substituted, the bites rapidly dimin- 
ished in frequency. 

Dr. Darrach exhibited a perfect insect of the 
mirmellion or ant lion. 

Dr. Fisher, on behalf of the Committee on 
Proceedings, announced the publication of the 
numberfor September. 



EDITORIAL DEPARTMENT. 



PERISCOPE 



CHLOROSIS IN CHILDREN. 

Under the title, "Researches on Chlorosis, 
especially viewed as occurring in children," Dr. 
NoNAT, physician to the ChariU, has, at a recent 
meeting of the Academie de Medicine, communi- 
cated a paper, a full abstract of which is pub- 
lished in a recent number of the Gazette Heh- 
domadaire, of which we avail ourselves to lay be- 
fore our readers his views on this interesting 
subject of infantile pathology. 

Of 68 cases of chlorosis in children, observed 
by Dr. Nonat, 27 occurred in boys and 41 in 
girls. As to age, these were distributed as fol- 
lows : — 



nder 1 year, 


3 


cases. 


rom 1 to 


2 years, 17 




- 2 " 


3 


6 




" 3 - 


4 


5 




" 4 '* 


5 


4 




u 5 u 


6 


6 




u 6 .. 


7 


4 




** 7 '* 


8 


7 




" 8 " 


10 


5 




" 10 " 


15 


' 11 





These figures show, first, that chlorosis exists 
in infancy, and that it is found in the first months 
of life ; secondly, that it is common to children 
of both s^xes ; thirdly, that it is much more 
frequent in girls than in boys. 

From his observations, Dr. Nonat concludes 



that, without exaggeration, about eight-twelfths 
of all children are affected with chlorosis. 

Chlorosis is essentially hereditary. It has 
requently been observed simultaneously in the 
mother and offspring, and often been met with 
in children of the same family. The writer has 
seen six, seven, and even eight chlorotic chil- 
dren from the same descendancy. 

Bad hygienic conditions, of food and habita- 
tion, have an immense influence upon the pro- 
gress and evolution of chlorotic phenomena, 
which they always aggravate ; but they cannot, 
according to Dr. Nonat's opinion, be considered 
as properly pathogenic to chlorosis. 

According to the author's further observa- 
tions, chlorosis manifests itself in children a^t^ays 
by the pathognomonic bellows-murmur ; very 
frequently hj discoloration of the integuments, the 
decline of strength and muscular power, and by 
various troubles of the digestive functions. But 
the nervous accidents which are so often seen 
in young chlorotic girls after the age of puberty, 
are very rare in children. 

Chlorosis exercises a deleterious influence 
upon the regular development of the organism, 
rendering its subjects liable to succumb to mor- 
bific causes, etc. 

After discussing the value of iron in the treat- 
ment of chlorosis, which the author does not 
consider as a specific, though he looks upon it 
as a most valuable remedy, in connection with 
proper food, exercise, good air, etc., he arrives 
at the following conclusions : — 

1. Chlorosis is a congenital, original disease, 
which precedes functionally the abatement of 
the force of hgematosis. 

2. Chlorosis is essentially distinct from anae- 
mia. These two morbid conditions differ from 
each other in their etiology, their alteration of 
the blood, the progress of their symptoms, and 
the treatment adapted to them. 

3. Chlorosis constitutes a morbid unity ; it is 
always idiopathic, and the various chlorotic 
symptoms described by authors must be re- 
ferred to different forms of anaemia. 

4. Chlorosis does not exclusively belong to 
the female sex ; it is also observed in the male, 
but less frequently. 

5. Far from being the result of a suppression 
or of a retention of menstruation, it is often the 
cause of these accidents. 

6. Chlorosis is not a disease peculiar to the 
age of puberty; it is found at all periods of life. 

7. It is very frequent in children, where 
hitherto it has not been sufficiently observed 
and studied. 

8. Chlorosis exercises a prejudicial influence 
upon the development of the organism ; it plays 
an important part in the production of diseases, 
and contributes to hasten their march and re- 
tard convalescence. 

9. Iron is not a specific in chlorosis, such as 
is mercury in syphilis and quinia in intermit- 
tent fever. Chlorosis is cured spontaneously 
with age, in consequence of the regular de- 



94 



PEEISCOPE— EDITOEIAL. 



Vol. V. No. 4. 



velopment of tlie organism. Notwithstanding, 
liowever, it is necessary to administer ferru- 
ginous preparations, which constitute, so far, 
the most efficacious auxiliary treatment of 
chlorosis. 



MR. HANCOCK S OPERATION FOR HYDROPHTHALMIA. 

The Paris correspondent of the Lancet 
says: — 

M. Coursserant, after reminding the society 
of the difficulties and ill-success attending the 
treatment of most of the organic changes in the 
structure of the eye, introduced to their notice 
the? particulars of a case of hydrophthalmia, in 
which the plan of treatment originated by Mr. 
Hancock had been adopted and followed by ex- 
cellent results. M. Coursserant said that he 
agreed with Mr. Hancock in believing that the 
excessive outpouring of fluid in the eye, and its 
over-distension, might be in some way con- 
nected with a too energetic and too permanent 
contraction of the tensor of the choroid, and, 
therefore, decided upon effecting the complete 
division of this muscle in the way recommended 
by the talented London surgeon. As hydroph- 
thalmia existed in both eyes, and was further- 
more congenital, the operation was undertaken 
as a sort of forlorn hope, and with no very san- 
guine expectation of success. The globe of the 
eye had attained, on either side, a volume double 
that of the normal state, and the amount of 
vision was nominal only, and utterly insuffi- 
cient for the purposes of locomotion. The dis- 
ease completely resisted all attempts at treat- 
ment, one of the means resorted to being paracentesis 
of the anterior chamber, performed every fortnight 
during the space of five months. A fortnight 
after the performance of Mr. Hancock's opera- 
tion, the patient, a child eight years of age, was 
able to run about and play with his schoolfel- 
lows, the eyesight being inconceivably im- 
proved, and the volume of the globe considera- 
bly diminished. The testimony of M. Coursse- 
rant, added to the already-expressed approba- 
tion of M. Desmarres, who has tried the opera- 
tion in glaucoma, will, I trust, prove a suffi- 
cient answer to those gentlemen who have 
hitherto chosen to shut their eyes to the value 
of Mr. Hancock's method, and who, in their 
blind attachment to irridectomy, have thought 
fit to condemn, and apparently without trial, a 
surgical novelty which, in other hands, has 
yielded, and still does yield, most excellent re- 
sults. 



HYPOCHONDRIACAL CONCEPTIONS A PRECURSOR OF 
GENERAL PARALYSIS. 

M. Baillarger, one of the physicians of the 
Saltpetriere, and a distinguished "alienist," be- 
lieves hypochondriacal melancholy to be a re- 
liable precursor of general paralysis. M. Bail- 
larger, as quoted by the Lancet, says : — 



The distorted conceptions of those laboring 
under hypochondriacal melancholy are, it is 
true, most varied and capricious ; there are, 
however, certain elements of similitude which 
act as guides in the recognition of the symp- 
tom. One of these is the systematic obstinacy 
evinced by the patient in himself producing the 
disturbance of function of which he complains. 
One man, for example, imagines himself dumb, 
and resolutely keeps his mouth closed ; another, 
that he is blind, and in the same way refuses to 
open his eyes ; and so on. In all the cases thus 
primarily affected with these distorted concep- 
tions, and which M. Baillarger has been able 
to follow up, general paralysis has, sooner or 
later, been found to occur with unvarying regu- 
larity.'' 

THE MEDICAL AND SURGICAL REPORTER. 

PHILADELPHIA, SATURDAY, OCTOBER 27, 1860. 

"TEMPOEA!" MOEES! 

In looking at the manifestations of our social 
and civil institutions, it is astonishing to observe 
the india-rubber quality of public opinion, pub- 
lic conscience, and public morality. 

Yesterday hailing with wild shouts of patri- 
otic sympathy the exile from foreign lands, the 
victim of king-craft, to-day going in extacies 
over the representatives of a semi-barbarous 
race, and to-morrow putting on tinsels and the 
fool's cap, and turning somersaults for the 
amusement of royalty, amidst the clamors and 
shouts of a presidential contest — truly no nation 
can compete with us in that wonderful attribute, 
which has, indeed, become a byeword among 
other nations — elasticity of public opinion. 

Of course, no man of common sense will find 
fault with this. "VVe are a young nation, prone 
to pranks and freaks, and public opinion with 
us is a foot-ball which everybody kicks as he 
pleases, and in any direction which he chooses, 
provided he can get a chance. In the course 
of time, our nation will ha^^e sown its wild 
oats, and spend its energies in more sensible 
and profitable excitements than some of those 
which have lately been witnessed. 

But while there need be no fear in regard to 
the effects of these sprees upon which our 
nation is bent, from time to time, and which 
may be considered, perhaps, in the light of 
safety-valves to let off superfluous steam, that 



October 27, 1860. 



EDITOEIAL 



95 



might otherwise lead to serious catastrophies, 
there is danger that public conscience and mora- 
lity, in some respects, has been so much and so 
continually put on the stretch, that its elasticity 
is almost entirely gone, that it is doubtful 
whether it will ever recover its normal con- 
dition. 

To no particular instance does this remark 
apply more forcibly than to the relations of 
woman, as a mother to the state. 

Madame Restell has been allowed to go un- 
punished. Mershon, after having plead guilty 
of the charge of criminal abortion, was punished 
merely by a nominal fine. Hundreds of similar 
instances might be adduced. There are thou- 
sands upon thousands of Restells and Mershons 
all through the country doing a thriving busi- 
ness in murdering children. 

Then, again, the ways and means to accom- 
plish abortion are freely and openly offered to 
the people by the public prints. It is but a 
few days ago, that we read in the i^ew York 
Daily Times an advertisement inviting all those 
with whose health or circumstances it does not 
agree to become mothers, to apply by letter to 
a certain address, and for a certain sum obtain 
the surest means to prevent the nuisance. It is 
supremely ridiculous to see some very excellent 
and, pious religious papers, so called, raise their 
hands in horror above their heads at the out- 
rage upon morals and decency committed by a 
daily -secular paper in publishing theatrical 
advertisements, while they have not a word to 
say against the whole array of murdering 
advertisements published in the secular press, 
and, aye, while publishing them themselves. 

Now, it is evident that there must be some 
general cause that makes a crime, which the 
world over is considered as one of the most 
dastardly, so common ; and a reason, aside 
from legal leniency, which makes judges and 
district attorneys and grand juries look with 
indifference at the punishment or escape of the 
criminal abortionist ; there must be something 
in the public conscience which allows newspa- 
pers to advertise the ways and means of com- 
mitting this species of murder. 

Suppose to-morrow, on opening their morning 



papers, the five or six millions of reading men 
and women of this country would find,flamingly 
displayed, an advertisement somewhat as fol- 
lows : 

Attention! — A jSure Method! — New Invention. — 
All those to whom certain parties are obnoxious, 
and who wish to get rid of them in a quiet and 
certain manner, may accomplish their object 
without fail by getting a vial of Killberry's 
celebrated concentrated essence, which has 
never been known to fail, and is undiscoverable 
by chemical or any other means. Directions 
sent with the bottle. The attention of fast young 
men and women, waiting to inherit riches from 
old uncles or aunts, is particularly requested. 

We dare say that an advertisement of this sort 
would speedily be followed by the arraignment 
before Judge Lynch of every editor, or owner of 
types, connected with the villainous advertise- 
ment. 

And yet, what is the difference between this 
imaginary advertisement and those published 
in the New York Times, et id omne genus, 
circulating in our households? What is the 
difference between the men who lend their 
sheets to advertisements of child-murder, and 
the man who would stand in the public square 
openly inviting the passer-by to buy a sure 
poison, with which to kill those whom he 
hates? 

But, shocking as the picture is, desponding 
as it is to contemplate the utter "moral idiocy'* 
manifest in such conduct, yet more degrading 
to our national pride, is the idea, that, in this 
respect, the newspapers appear but to reecho 
the moral sentiments of the community, for 
else, how could we explain the quiet submission 
to such shameful conduct ? What has become 
of public conscience, of public morality, when 
child-murder has become perfectly acclimated, 
and when people are openly invited to buy the 
means with which to commit it? Where is 
our vaunted civilization, where the progress of 
which we can feel proud, where the exemplary 
Christianity of which we boast, where are law 
and justice, and where is humanity, when 
murder is reduced to a matter of daily expe- 
diency, when newspapers /;ome to us laden 
with the beastly fragrance of invitations to 
child-murder ? 



EDITOEIAL. 



VoL.V. No. 4. 



Cannot the press be forced by a regenerated | adopted, are the very best that could be carried 



public opinion to put a stop to their tempting 
and inciting men and women to commit murder? 
Is it not time that Grand Juries should take 
hold of the matter ? 



MEDICAL JURISPKUDENCE. 
It is a curious fact, that in no country through- 
out the civilized world is medical jurispru- 
dence, or, if we wish to go a step beyond, and 
include public hygiene, is State medicine more 
neglected as a scientific study than in the 
United States; and that we can yet boast of 
having in the work of the Becks the most 
complete and classical work on the subject in 
the English or in any other language. 

Yet, in measuring the standard of medico- 
legal science of a country, it would be futile to 
point to a few excellent treatises that have been 
published on the subject, and therefrom to esti- 
mate the state of the science. For, while fully 
appreciating such works as those of the Becks, 
Elwell, etc., we cannot be blind to the fact? 
that, while they are monuments of the scholar- 
ship, learning, and industry of their authors, 
they are indirectly a testimonium paupertatis to 
the profession. For it can scarcely reflect to 
the credit of American science when regarding 
so highly important a branch of medicine as 
medical jurisprudence, that it can point to but two 
or three books as the sole instructors and au- 
thorities on the subject, however excellent these 
instructors and undoubted these authorities 
may be. 

It may not be amiss, in a discussion on this 
subject, to start with the statement at once 
plain and palpable, that the present system of 
education throughout the country, in this re- 
spect, as a general rule, is miserably defective* 
There are indeed some who would attempt, for 
reasons more apparent, undoubtedly, to them- 
selves than to others, in apologizing for the 
present defects in teaching forensic medicine, 
the plea generally being that the limited time 
does not allow of considering the subject exten- 
sively. But, almost with the same breath, we 
are frequently assured that the present system 
of teaching, and the curriculum now generally 



out, and that, after all, it was a serious ques- 
tion whether medical jurisprudence should not 
be left to be acquired after the student has gra- 
duated. To both of these points we shall refer 
as far as our space permits. 

In the first place, if, with the admitted im- 
portance of medical jurisprudence, it cannot be 
fully taught and elaborated on account of the 
limited time, this forms one of the most forci- 
ble reasons why the time for study should be 
extended. The occasional plea that it can be 
acquired after graduation must be considered 
a subterfuge. For, in the first place, the young 
physician's time is too much taken up, in the 
majority of cases, to apply himself to a syste- 
matic study like that of medical jurisprudence; 
and the latter itself is so wide and extended in 
its scope, that it requires something more than 
the mere reading of a text-book to acquire it. 
The subject can, perhaps, best be illustrated by 
a case. 

A young physician, just graduated, locates 
himself in a town and puts out his " shingle. '^ It 
is not very likely that he will be called at once 
to the first families in the place ; but it is much 
more probable that he may be summoned sud- 
denly to the river's side, where a man has just 
been found drowned. It is his business to dis- 
tinguish between death before immersion or 
death from drowning; whether any injuries 
have been inflicted before death or not. Sus- 
picion falls upon certain persons to have stran- 
gled the man and thrown him into the water. 
He is to tell whether the man was strangled or 
drowned, whether he was in articulo mortis 
when he fell in, or was thrown into the river 
in perfect health. An eager crowd is enlivening 
the scene. Theories of foul play are abundant ; 
and the physician's every movement, nod, or 
wink are closely watched. A coroner's jury is 
summoned, and an order for a post-mortem 
examination given. Imagine the fearful respon- 
sibility which rests upon the physician, if per- 
sons are held in arrest to be liberated or sent to 
their trial for murder on his testimony. All 
this may happen within a week after he has 
graduated and located himself; and yet we are 



October 27, 1860. 



EDITOEIAL. 



97 



told that it is a matter of serious consideration 
whether medical jurisprudence should not be 
left to be acquired after graduation ! 

What is the young physician to do ? There 
is time for but a hasty consultation of books, 
and fortunately for him if he escapes from that 
with his ideas unconfused and his common 
sense unimpaired. 

But, it is said sometimes, that medical juris- 
prudence being in fact made up of all other 
branches of medical science, he who is versed 
in the latter, is capable, eo ipso to solve ques- 
tions of forensic medicine. This, again, is an 
untenable position. Physiology, even if taught 
experimentally, cannot settle the intricate 
questions of infanticide, or of strangulation, 
suffocation, and drowning. All these conditions 
must be studied by themselves as facts, and the 
questions involved in them cannot be solved on 
theoretical principles whatsoever. 

A great deal of mischief has been done to the 
profession by the ignorance of medical wit- 
nesses of medico-legal questions, and we doubt 
whether there is any one cause which has con- 
tributed so much in undermining the confidence 
of the public toward the healing art, as the 
looseness displayed by the profession in regard 
to their duties toward the Commonwealth. We 
attach no blame anywhere, because this state 
of things has been brought about by the rapid 
development of the material interests of the 
natioi>, which has rendered our scientific pro- 
gress necessarily more or less superficial. 

But we think it is time that attention should 
at least be called to one of the greatest deficien- 
cies in our medical education. If the time may 
yet not be at hand for distinct professorships of 
public hygiene and medical jurisprudence in 
our medical schools, let, at least, the medical 
institutions of the country feel proud of not 
sending their graduates adrift without a full 
idea of their responsibility to the State and a 
knowledge of the most important questions of 
medical jurisprudence, so that they may do 
credit to themselves, and elevate the position 
of medicine among their fellow-men. 



SPIRIT OF THF MEDICAL PRESS. 

Under the heading " Deficiencies in the 
Schools,^' the London Lancet, of October 6th, 
has an editorial which puts the matter of medi- 
cal EDUCATION IN ENGLAND in auj^thing but a 
favorable light. 

Of anatomy, it says, that " anatomical study 
is universally obstructed in the metropolitan 
schools by one prime difficulty — the scantiness 
and cost of anatomical subjects. It is impossi- 
ble that a majority of medical students in Eng- 
land should dissect, as do continental students ; 
it is impossible that they should acquire that 
full, practical acquaintance with the topography 
and manipulation of the human organs, which 
is agreed on all hands to be the basis of sound 
medicine and surgery, without a tenfold more 
numerous supply of subjects than is accorded by 
the present legislative restrictions.'^ 

Again, in reference to the study and practice 
of surgical operations upon the dead body, the 
Lancet says, that they are practically impossible. 
" The cost of a subject ranges between four and 
five pounds sterling, and the fee for the professor 
amounts to about an equal sum. This is nearly 
prohibitive of the performance of one series of 
operations on the dead body prior to practice on 
the living. '^ 

In regard to clinical teaching, the Lancet says 
that is a shadow of a name in many of the Eng- 
lish Hospitals. 

"Often this is less the fault of the teacher, 
scientifically, than the necessity of his position. 
A surgeon or physician, who is able to devote 
but an hour or two hours twice or thrice a week 
to the investigation of from thirty to a hundred 
cases distributed over the wards of a large build- 
ing, can do little in personal clinical study of 
his cases — nothing whatever in useful clinical 
teaching. To " walk the hospital" in the suite 
of the surgeon or physician making his rounds 
is commonly to do no more than the phrase lite- 
rally expresses. He is compelled necessarily to 
pass rapidly from bed to bed — here a prescrip- 
tion — there a few words of clinical observation ; 
and, as he passes, some further words to those 
nearest to him. But clinical teaching implies 
ten minutes — half an hour — it may be more — 
spent at one bed. This a physician will often 
need to help him to determine the character or 
the progress of a disease for himself; but to 
teach a following of pupils, or even a few of 
them, to trace the course of reasoning and ob- 
servation which is implied in the profitable 
clinical study of a case must necessarily be the 
work of a longer period of time. The most 
readily effective reform would be to raise the 
assistant physician and surgeons to active duties 
in the wards, and to abolish the injurious and 
unmeaning title of 'assistant.' " 



98 



COEEESPONDENCE. 



Vol. V. No. 4. 



It will be f?een from these extracts that our 
English friends have not yet reached the climax 
of perfection, and that with them, as with us, 
there is ample room for improvement. 



EUKOPEAN CORRESPONDENCE, 
Edinburgh : her Medical Institutions— Ununited Fracture— Mr. 
Syme— Botanic Gardens— University of Edinburgh 

Edinburgh, October 1, 1860. 
Editors of Medical and Surgical Reporter : 

Gentlemen: — According to my promise, I 
must send 3^ou a letter from this beautiful city, 
which, certainly, for picturesqueness of situa- 
tion, surpasses all that I have seen. 

The deep ravine, which runs through the 
centre, separating the old town from the new, 
and the public buildings and monuments, situ- 
ated on its sides, or on eminences visible from 
it, produce an effect which I had indeed heard 
of as very beautiful, but which, I confess, I 
had been far from appreciating sufficiently. 

In looking over the guide-book, as I always 
do before arriving at a city, I sought for an 
account of the Medical Institutions here, and I 
was not long in finding, under the head of hos- 
pitals, accounts of several, — Heriot's Hospital, 
and many others. Upon reading further, how- 
ever, I discovered that, although named hos- 
pitals, they are, in reality, neither more nor 
less than orphan asylums, founded by the indi- 
vidual whose name they bear. The real hos- 
pital was not described in the book I refer to 
at all, but I was not long in finding it out with- 
out any help from the guide. It is called the 
Edinburgh Eoyal Infirmary, and is situated in 
the old town, close to the University buildings. 
It usually has about 400 patients in it, or, per- 
haps, 500, but, in case of necessity, the number 
can be increased to 800 — 500 surgical and 300 
medical. The buildings are a large and irre- 
gular pile. Over the front door is a statue of 
George II., and on either side is an inscription 
in large capitals ; on one side, " I was naked 
and ye clothed me,'' and on the other, " I was 
sick and ye visited me.'' In the vestibule, the 
names of the donators of large sums are in- 
scribed in gilt letters. 

In the hospital, I saw a few surgical cases, 
not of any interest in themselves, but perhaps 
one or two of them may be of interest to your 
readers as illustrating the method of practice 
of Mr. Syme. 

There was one man who had broken his 
right humerus thirteen weeks before I saw him, 
and the bones not having grown together soon 
enough, an operation for ununited fracture had 



Simpson. 



been performed, by cutting down and sawing 
off the ends of the bones. The wound had 
taken on unhealthy action for a few days, but, 
when I saw it, it was doing very well, and dis- 
charging healthy pus, and plenty of it. I was 
informed that Mr. Syme considered no other 
operation of any more use than perfect rest 
would be. 

The fractures of the leg are usually treated, 
after the first few days, by stiff pasteboard 
splints. On the leg which I noticed, they had 
been applied to the limb, without any bandage 
having been previously put on, so that there 
was a good deal of puffiness in some places, 
but I suppose not enough to cause any serious 
inconvenience. 

Fractures of the thigh are treated by Desault's '; 
apparatus, unmodified — at least so far as the 
inside splint is concerned. The limb is fastened 
to the long splint by the splint cloth, which, 
after passing once around the limb, is attached 
by the margin with pins to the splint. Late in 
the case short splints are applied to the thigh. 

I was informed that they always cured their 
cases without any shortening whatever, which, 
of course, is all nonsense. They probably never 
measure the two legs carefully to determine. 

I have mentioned the proximity of the Eoyal 
Infirmary to the University of Edinburgh. The 
latter is a large and imposing building. It 
contains within its walls a museum on various 
subjects, and also a library of 100,000 volumes. 

I will mention the names of some of the 
Professors. 

Dietetics, Materia Mediea, ] n„„^^^.^^.. 
7 DT y Ohristison. 

and Pharmacy, j 

Chemistry, - - - Lyon Playfair. 

Surgery, . - . Miller. 
^ Clinical Surgery, - - Syme. 

Clinical Medicine, - | g^J^^^^T*. 

Anatomy - _ - Goodsir. 
Midivifery, and Diseases of\ 
Women and Children, j 
Practice of Physic, - Laycock. 

Botany, - - - Balfour. 
The Professor of Botany is enabled to illus- 
trate his branch by the Botanie Garden which 
he superintends, and by a large herbarium, of 
which he has the control. 

The botanic garden covers seventeen acres, 
and contains several hot houses, one of which, 
the palm house, is very lofty, three or four feet 
higher than the palm house at Kew Gardens. 

There is a large number of medicinal plants, 
in some of which I took a special interest, as 
they were entirely new to me. Such were Nar- 
thex Assafoetida, Ipomea Jalapa, the Scammony 
plant, and the plant producing the true Gam- 
boge. 

In other cities in which I have been, there 
are large botanic gardens. Such were in Glasgow 
and Belfast. In the last named, I observed a 
special part of the ground reserved for medi- 
cinal plants, which were arranged according to 



October 27, 1860. 



COEEESPONDEKCE. 



99 



their natural orders. I spent some time in 
examining them. 

Before coming to Edinburgh, I was for a 
short time in Dundee, the third city in Scotland 
in point of population, containing about 80,000 
inhabitants. While there, I visited the hos- 
pital, which is the finest building in the city. 
It is situated on the side of a high hill, in the 
outskirts of the city, and from the terrace in 
front of it there is a very fine view. I should 
think there would be a fine view were it not 
for the thick smoke, which there, as in Man- 
chester and Birmingham, obscures everything. 

The hospital is in the Tudor style of archi- 
tecture, somewhat of the same shape as the 
Pennsylvania Hospital, but with the centre 
more projecting, and less projections at the ex- 
tremities of the wings. The building as a whole, 
however, is larger than our hospital at home. 
It is three stories high. The fever patients 
are accommodated at the top, it being supposed 
that the danger of contagion will in that way 
be obviated. 

The number of students at the University of 
Edinburgh is about 1,500, one-third of whom 
are students of medicine. In former days, there 
was an ill feeling between them and the town's 
people, and combats were frequent and fierce, 
but the present race is more peaceable. While 
on the subject of the characteristics of students, 
I may mention that the mania for destroying 
the benches to which they owe their rest is 
not confined to the United States. At the 
Queen's College, in Belfast, I observed the same 
deep-carved work, and I have seen it also in 
other places. I never saw the inconvenince of 
it so much as in Gruy's Hospital, London, 
where the students are all obliged to stand, the 
benches having disappeared altogether. I won- 
dered if this was not in punishment for the 
greater love for whittling. 

There is in Edinburgh, with its 300,000 in- 
habitants, and its great reputation as a centre 
for medical education, only one journal de- 
voted to medical subjects, and in that the Pro- 
fessors of the University have no portion. It 
is conducted by other men. It is much to be 
hoped that the University may start a journal, 
and now there is some talk of it, I believe. 
Very truly, yours, 

M. D. Abroad. 



MORTALITY IN PHILADELPHIA. 

[A prominent sanatarian, not of this city, 
however, writes us the following, to which we 
call the attention of sanitarians in this city:] 

In studying the mortality of different cities, I 
have the following facts in relation to Philadel- 
phia, which have not been published. During 
the three months, July 1 to September 29, 1860, 
there were 3,462 deaths in Philadelphia. Last 
year the number in the same time was 2,650. 
This is an increase of 812, or 30.6 per cent, in 



the mortality. This increase the present year 
is very large, much larger than in any other 
city with which I am acquainted. In Provi- 
dence, during the same time, the increase has 
been about 9 per cent. Of the 3,462 deaths in 
Philadelphia, as above, 1,942, or 56 per cent., 
were under 5 years of age ; and 659, or 19 per 
cent., were from the four diseases cholera infan- 
tum, cholera morbus, diarrhoea, and dysentery. 
I should like to know your ideas of the causes 
of this large increase in the mortality of your 
city. Has the law that went into operation the 
first day of July anything to do with it ? 



NEWS AND MISCELLANY. 

Introductories in New York. — The opening ex- 
ercises of the Medical Colleges in New York 
city took place this week, and the week before. 

The Opening of the College of Physicians and Sur- 
geons was additionally interesting, from the fact 
that it was the formal union of the institution 
with Columbia College, of which, hereafter, it 
will form the medical department. 

Dr. Delafield, President of the College of 
Physicians and Surgeons, presided. He made 
a few introductory remarks, characterizing as 
a most auspicious event in the history of their 
institution their union with Columbia College. 
Incorporated forty-three years ago, and placed 
under the custodiorship of the Eegents of the 
University, their college had not had that suc- 
cess it merited. No blame was to be imputed 
to the Eegents, but the remoteness of the latter 
prevented prompt attention to their merits and 
requisitions. In response to their affliction, the 
Legislature, last winter, granted them a new 
and independent charter, and under this they 
had associated themselves with that time-ho- 
nored institution, Columbia College. From this 
union he augured the happiest results. It was 
a union of which they were justly proud. 

Professor John C. Dalton, Jr., delivered the 
introductory address, commencing with the dis- 
covery of the lacteal vessels by Andre Vesalius, 
in an Anatomical College, in Paris. He traced 
the progress of medical science, touching the 
circulation of blood, down to the present time. 
He showed how, step by step, the discoveries 
now so familiar to the medical faculty Avere 
made. For three-fourths of a century, the 
blood insisted on running the wrong way. Not 
till Harvey made his important discovery were 
the previous obscurities surrounding the subject 
fully cleared up. Harvey saw irregularities 
and contradictions. The earnest student-life 



100 



NEWS AND MISCELLANY. 



Vol. V. No. 4. 



and discovery of Harvey, Dr. Dalton enforced 
as affording a noticeable example to the stu- 
dents of medicine of the present age. Advanced 
as tliey were in medical knowledge, the learn- 
ing of to-day, in many things, he urged them to 
recollect, might be the ignorance of to-morrow. 
No matter how old a doctrine, or how repu- 
table, they must not bow to old dogmas. They 
must think for themselves — believe for them- 
selves — do for themselves. 

President Kixg made an address next. He 
stood before them (he began) in the posi- 
tion he ought to have occupied years since. 
In again establishing a medical department 
in Columbia College, and uniting it with the 
College of Physicians and Surgeons, they 
had only yielded to the behests of the age. 
He hoped the union would prove one and in- 
separable [loud and prolonged cheers] under 
the old colonial government. Then the insti- 
tution, over which he had the distinguished 
honor to preside, was called King's College : there 
was a medical bench of instruction. The war 
of the revolution broke up the college, and the 
buildings were turned into hospitals. How 
well the students of that time exchanged the 
pen for the sword, was shown in the case of 
Alexander Hamilton. In 1767 was incorpo- 
rated the first medical faculty — a faculty as 
learned in their various specialties as any in 
the New World. In 1784 a medical faculty 
was again incorporated, and the study of medi- 
cine was a specific branch of instruction in that 
institution until 1813, when it was aban- 
doned. Leading to its abandonment was the 
incorporation, in 1807, by the Regents of the 
University of the College of Physicians and 
Surgeons. New York was only a big vil- 
lage then. They did not need the medical 
colleges. Among the members of the late 
medical faculty was the venerable Valentixe 
MoTT, the sole survivor of his olden compeers 
and co-workers. Matters now in the metropolis 
had changed. The trustees of Columbia Col- 
lege felt admonished of the necessity of reviving 
their medical department. Now they would 
have a literary, law, and medical department 
combined, and still each distinct, but together 
furnishing the needed elements of a complete 
university education. 

In conclusion, President King briefly ad- 
dressed the medical students, urging them to 
value correctly the profession to which they 
were to devote themselves. 

Dr. Stevens, former President of the medi- 
cal college, followed, with a few remarks, show- 
ing the necessity of a classical and mathemati- 
cal education to a thorough medical training. 

At the Medical Department of the Umversity of 
the City of New York, Dr. Valextixe Mott deli- 
vered the introductory. 

At the Nevj York Medical College, Dr. R. Ogden 
DoREMus, Professor of Chemistry, and Dean of 
the Faculty, delivered the opening address. He 
expressed his sense of the honor conferred upon 



him in being invited to open the course of lec- 
tures for the season, and hoped that those who 
had opportunity to attend them during the 
winter would derive much valuable informa- 
tion. He next proceeded to give a number of 
experiments with gas, mercury, water, carbonic 
acid, ether, &c., which he accompanied by full 
explanations. 

At the conclusion, Dr. Doremus spoke of the 
duties and requisites of persons engaged in the 
medical profession. A good physician should 
understand all the sciences which have any 
relation to his profession. He should know, 
how to prevent the inroads of disease, as well I 
as to treat it where it existed. The professor 
spoke in complimentary terms of the establish- 
ment of a hospital by Dr. Barker in connec- 
tion with the institution. He spoke of the 
great good which must result from the estab- 
lishment of the hospital now commenced, and 
the wards for the treatment of patients. He 
asked for the co-operation of the trustees as well 
as the ladies and gentlemen present, und re- 
ferred in a strain of commendation to the efforts 
of those who had aided in the work. 



Case of Supposed Poisoning. — A case to which 
some interest attaches, happened recently in 
New York. The subject was a formerly noto- 
rious courtesan, who died suddenly. She was 
found on the floor beside the bed, with her face 
down. Deceased, it appeared, arose as usual 
on Friday (Oct. 12th) morning and took her 
breakfast. Soon after partaking of that meal, 
she retired to her bedroom, while her husband 
proceeded down town on business. In an hour 
or so afterwards, one of the inmates had occa- 
sion to enter her room, when she was found 
lying dead on the floor. In reference to the 
cause of death, the following medical testimony 
will throw light : 

Statement of Drs. Sands and Finnell. — Drs. 
Sands and Finnell, being duly sworn, say 
that they made a post mortem examina- 
tion of the body of Mrs. J. A. Blankman, at 
her late residence. No. 49 West Thirty-fourth 
street, on Saturday, October 13, 1860. The 
following gentlemen were present : Drs, Willard 
Parker, Blankman, Kissam, Wm. H. Draper, 
Foster, Swift, and Reisig. The examination 
was made twenty-four hours after death ; the 
body of the deceased presented no external 
marks of violence ; the surface was pale, and 
there were no evidences of commencing decom- 
position ; the pupils were of natural size ; the 
thorax and abdomen were the parts first exam- 
ined, an incision having been made from the 
top of the sternum to the pubes ; the abdominal 
walls were found loaded with fat, measuring 
upward of an inch and a half in thickness ; the 
lungs were next exposed to view, by removal 
of the sternum and costal cartilages ; they 



October 27, 1860. 



NEWS AND MISCELLANY. 



101 



crepitated freely; and presented a healthy ap- 
pearance everywhere, except at their apices, 
where their substance was puckered, apparently 
from old tubercular deposition ; there were no 
signs of unusual congestion of these organs, nor 
was there any effusion in the pleural cavities ; 
the pericardium was now opened, and found to 
contain about an ounce of yellow, transparent 
eerum ; the heart was of normal size, but was 
greatly loaded with fat, which encroached con- 
siderably upon the muscular tissue of the right 
ventricle ; the cavities of the heart were healthy ; 
the ventricles were empty, and the auricles con- 
tained a moderate quantity of blood, partly 
coagulated ; the valves were healthy, presenting 
neither thickening, calcareous deposit, nor any 
other morbid change ; the abdominal organs 
were next examined, and exhibited the follow- 
ing appearances: the liver was somewhat larger 
than natural, but otherwise free from disease, 
except towards its anterior free margin, where 
there were found two small nodules of cancerous 
deposit ; the kidneys were of nearly equal size, 
and showed no remarkable appearances ; they 
were deeply imbedded in fat, and on section 
were seen to be moderately congested ; the 
capsule stripped off easily, and the cortical and 
medullary portions of the organ were present 
in their due proportion ; the uterus was next 
removed from the pelvic cavity, and was found 
to be considerably enlarged from the effects of 
old chronic inflammation, which existed not 
only in the uterus itself, but also in its append- 
ages, causing abnormal adhesion of both fallo- 
pian tubes; the cavity of the body of the uterus 
was empty, and its lining membrane pale and 
thickened ; the cavity of the cervix was filled 
with, tough, viscid mucus ;• one of the ovaries 
was the seat of cyctic disease in its early stage, 
the other contained two Graafian vesicles filled 
with blood undergoing absorption. At this 
period of our investigation, Dr. Finnell having 
completed the removal of the calvarium, the 
contents of the cranial cavity were exposed to 
view, and made the subject of examination. 
The dura mater was healthy ; but in lifting this 
membrane from the surface of the brain, well- 
marked and unmistakeable evidences of apo- 
plectic extravasation were at once discovered ; 
the effused blood was spread out over the sur- 
face of the brain, beneath the arachnord mem- 
brane, and was in many places sufficiently 
abundant to entirely conceal the subjacent 
cerebral substance ; it extended over the lateral 
portions of each cerebral hemisphere, and cov- 
ered the base of the brain throughout, leaving 
but a small portion of the surface of the organ 
free from extravasation — this portion being 
situated at the summits of the hemispheres, 
the vessels at the base of the brain were exam- 
ined, and a large and well-marked deposit of 
atheronia discovered in the basilar artery. On 
making the section of the brain necessary for 
the exposure of the ventricles, its substance 
was seen to be healthy, and free from conges- 



tion ; the two lateral ventricles, as well as the 
fourth ventricle, each contained a quantity of 
coagulated blood ; the substance of the septum 
lucidum was exceedingly soft, but the walls of 
the ventricles were otherwise of about their 
usual consistency. The appearances just de- 
scribed were so decided and characteristic as to 
leave no doubt in the minds of all present that 
the deceased died from an attack of cerebral 
apoplexy. No further examination of the body 
was made, inasmuch as we had already discov- 
ered what, in the opinion of all parties who 
witnessed the autopsy, was the real, undoubted 
cause of death. When an individual is found 
dead, with his throat cut, his heart ruptured, 
or with a musket ball at the base of his brain, 
it is not generally considered necessary to 
search for poison in the contents of the stomach, 
and intestines, and, for a similar reason, no 
such inquiry was instituted in the present case. 
Having ascertained what was regarded as the 
true cause of death, a certificate was rendered 
in accordance with the facts observed. 

There can be no doubt as to the correctness 
of the conclusions arrived at by Drs. Sands and 
Finnell, that the woman died of cerebral apo- 
plexy. It seems, however, that "Madame 
Eumor'^ took hold of the case, spreading all 
sorts of stories about foul play, etc., so that, 
after the body had been buried, a coroner's in- 
vestigation was rendered necessary, the body 
exhumed, and a second examination made by 
Drs. Carnochan and Bronson, which, as far as 
it went, entirely corroborated the first. 

Parts of the body were also placed in the 
hands of Prof. Doremus for chemical analysis, 
but it seems that the authorities saw in time 
the ridiculous position in which they had per- 
mitted themselves to be placed by listening to 
"gossips," and the order was countermanded. 

It would be well if the New York officials 
were as anxious to do their duty in cases where 
poor girls are poisoned by the culpable neglect of 
druggists, as they have been in this instance, 
when a morbid appetite for scandal demanded the 
opening of the grave, because deceased had 
been a notorious woman, and left fifty thousand 
dollars. 



Investigations Concerning HydropJiohia. — From 
a series of returns made upon this subject, 
from different departments in France, dur- 
ing several years, and epitomized by Dr. Tar- 
dieu, in the Annates d' Hygiene Publique, we glean 
some interesting information upon the follow- 
ing points: — 

1. The Species of Animal by which Ilydrophohi 
was communicated. — Out of a total of 228 cas 
in which reference was made to this point, ^ 
were stated to have been produced by the ' 



102 



NEWS AND MISCELLANY, 



Vol. V. No. 4. 



of a dog, 13 by that of a cat, 26 of a wolf, and 1 
by the bite of a fox. In two cases in which the 
bite of a cat produced the disease, one animal 
is reported to have become rabid in consequence 
of an extensive burn, another owing to its hav- 
ing been robbed of its young. These cases are 
of considerable interest, as they tend to resolve 
the still doubtful question of the spontaneous 
development of hydrophobia in other species 
of animals than the canine. 

2. The season of the year at which this disorder is 
most frequently developed. — This circumstance was 
noted in 181 cases, 110 of which occurred dur- 
ing the hot season of the year, 71 only during 
the cold. There is, doubtless, a marked differ- 
ence in favor of the months in which the tem- 
perature is most elevated, but it does not remain 
a less constant fact that no season is really op- 
posed to the development of hydrophobia, or 
can render its effects less formidable. 

3. Tlie average number of persons who escaped 
the malady after being bitten. — On this point we 
have the records of 198 cases of persons who 
were bitten, in many instances by the same 
animal ; of these, 112 were subsequently seized 
with hydrophobia, whilst the remaining 86 ex- 
perienced no ill-effects. We need scarcely re- 
mark that numerous adventitious circum- 
stances, such as the interposition of an article 
of clothing to which the saliva of the rabid 
animal might adhere, the state of the patient's 
mind or health after the injury, &c., would con- 
siderably influence the results in this particular. 

4. The length of the stage of Incubation. — In a 
large majority of cases this was not more than 
a few weeks. Out of 147 cases referred to, the 
period of incubation was under a month in 26, 
more than a month but under three months in 
93 cases, whilst in the remainder the length of 
time occupied was from six to twelve months. 
The incubatory period appeared shorter in very 
young persons than at any other stage. 

5. The length of time between the development of 
the disease and its fatal termination. — On this point 
the statistics collected corroborate too fully the 
preconceived ideas, as to the rapid progress of 
the disorder. Out of 161 cases death put an 
end, within a week, to the horrible sufferings 
of the patients in 158, more than one-half of 
that number dying within four days, even, from 
the time at which the malady first manifested 
itself. 

6. The relative efficacy of the means employed to 
prevent the development of Hydrophobia. — Upon 
this all-important portion of the subject Dr. 

, Tardieu observes that the fact cannot be too 

strongly insisted upon that the only hopes of 

ecurity from the fatal effects of this dreadful 

"sease consist in immediate cauterisation with 

^ red-hot iron, and that every other method 

" comprises the future safety of the patient 

e irreparable loss of the only moments 

• which the preventive treatment is appli- 



7. Curative treatment of Hydrophobia when it has 
become developed. — Dr. Tardieu makes the dis- 
heartening statement that of all the remedies 
which have as yet been suggested, chloroform 
included, for the treatment of hydrophobia 
when fully developed, he has found none to 
have been attended with sufficiently promising 
results to enable him definitely to say that it 
will effect a cure — Lond. Med. Rev. 



Fees for Post Mortem Examinations — Opinion of 
a Judge. — The Board of Freeholders in New- 
ark, N. J., are still adhering to their stubborn 
resolution of denying to physicians a proper fee 
for services rendered to coroners in making 
post mortem examinations. The matter will, 
however, soon be brought to an issue. 

The subject, we learn, was brought before the 
court by the Prosecutor of the Pleas in behalf 
of one of the coroners. 

It was stated that a person found dead the 
night before was lying in the station house, 
and that the coroner had requested two phy- 
sicians to make a post mortem examina- 
tion, who had declined because of some action 
of the freeholders respecting fees. The court 
was desired to declare the law governing the 
subject, the question having lately frequently 
been raised in like cases. 

His Honor Judge Haines said : — This matter 
is perfectly plain from the provision of the 
statute. There can be no doubt that the coro- 
ner may and in some cases is bound to sum- 
mon a physician (or physicians as may be re- 
quired) to make a post mortem examination. 
There may be much or little labor in such an 
examination. That will depend on the subject 
and circumstances. We presume that- the regu- 
lation published by the Board of Chosen Free- 
holders is intended only as a warning to the coro- 
ners not to incur unnecessary expense in these 
matters. There are cases in which great labor 
and skill will be required to make an examina- 
tion. One physician or more, if necessary, may 
in such cases be called in, and he or they will, 
by law, be entitled to receive from the county 
proper compensation for their skill and labor 
expended in the matter. The freeholders in 
such cases will, undoubtedly, without hesitation, 
pay the bills. 



Where Does the Coffee Come From ? — Last year 
the total consumption of Europe and the United 
States alone was 330,000 tons, whilst the pro- 
duction of all countries was but 312,000 tons. 
The consumption of the present year is esti- 
mated at 337,000 tons, and the production at 
21 4:,Q00.— Century. 



Dengue or the Break-bone Fever is said to be 
generally prevalent in Memphis. It has pre- 
vailed, indeed, throughout the South and West 



to an extent never equalled previously, although 
in most cases in a light and tractable form, 
when promptly attended to. 



October 27, 1860. 



NEWS AND MISCELLANY. 



103 



The Anniversary of 8t. LuMs Hospital, in New 
York, was celebrated on Thursday evening of 
last week. 

Dr. Edward S, Dalton, resident physician, 
read the medical report. 

During the year there had been admitted into 
institution 468 patients. Of these 232_ were 
males and 326 females, including 55 children. 
There were now in the hospital 53 patients. 
During the year 59 had died. Most of the deaths 
were of those brought into the hospital in the 
last stages of pulmonary disease. By the care 
taken of these, the abundant ventilation and 
quality of food furnished them, the lives of 
many had been greatly prolonged. A good 
many of the patients were victims of accidents 
in the erection of buildings in the vicinity, 
which had necessiated twenty-one surgical ope- 
rations, eight of mortal character. The per 
centage of deaths had been fourteen, which 
was five per cent, less than the year previous. 



The Hetirevtent of Ricord. — M. Ricord has re- 
signed trom his post as surgeon of the Hospital 
du Midi. The hospital regulation which re- 
quires the retirement of medical officers at the 
age of sixty, would soon have completed his 
term of service, but he has chosen a more dig- 
nified leave by resignation. 

Eicord was born in Baltimore on the 10th of 
December, 1800, and has held his position in 
the hospital for nearly thirty years. His op- 
portunities have been unequaled, and his great 
reputation has been the result of immense labor 
and observation on the specialty which is so 
much indebted to him for its development. 

Eicord's place, it is said, is to be filled by one 
whose name is not unknown in syphilography 
— M. Alphonse Guerin. 



A Case of Cysticercus has been recently under 
the care of M. Desmarres, of Paris. The para- 
site occupies a position in the vitreous humor, 
and being in the axis of vision, sight is ob- 
scured. Previous failure of operations in such 
cases has determined a non-interference in this 
case. 



Professor W. H. N. Magruder, Baton Eouge, 
La., is collecting materials for a biography of 
the late Dr. Drake. All who have any letters 
or papers, or are acquainted with any facts or 
incidents, which may be of value in the prepa- 
ration of such a work, will please address Prof. 
M., as above. 



Dr. TurnhulVs regular course of lectures on the 
eye and ear will be commenced on Thursday, 
November the 1st, at half-past seven o'clock, 
evening, and will be continued at the same day 
and hour until the 1st of March, at his resi- 
dence, 1208 Spruce street. 



Army and Navy. — Assistant Surgeon W. W. 
Anderson has been assigned to duty at Fort 
Chadbourne, Texas. 

Leave of absence for four months has been 
granted to Assistant Surgeon E. W. Johns, 
Medical Department. 

Assistant Surgeon Abel F. Mechem (lately 
appointed) has been assigned the duty with the 
recruits for San Francisco, on the 20th instant. 
He will afterwards report for duty to the Com- 
mander of the Department of California. 

Assistant Surgeon A. B. Hasson is to resume 
his duties at Fort Dallas. 

Assistant Surgeon L. Taylor, is to report for 
dutv to the Senior Medical Officer at Fort Walla 
Walla, W. I. 

Assistant Surgeon Clinton Wagner (lately 
appointed) has been assigned the duty with 
the recruits to leave Carlisle Barracks for 
Texas, via Fort Leavenworth, on the 31st inst. 
He will, afterwards, report for duty to the Com- 
manding Officer of the Department of Texas. 

Assistant Surgeon Gr. K. Wood has been as- 
signed to duty with the recruits for Texas on 
the 31st inst. He will, afterwards, report for 
duty to the Commanding Officer of the Depart- 
ment of Texas. 



Accidental Poisoning hy Arsenic. — Three men in 
the employ of Messrs. Crum and Thernliebank, 
of Glasgow, boiled some potatoes in a dish used 
for the purpose of lifting a liquor employed in 
some process of bleaching. The three men 
having eaten heartily of the potatoes, v/ere 
seized with violent pain and vomiting, but ulti- 
mately recovered. It appeared that the liquor 
for which the dish had been used, contained a 
large quantity of arsenic and chlorate of potash, 
with which the potatoes had been impregnated. 
— Dublin Press. 



On the Preparation of Antimoniate of Potash. — 
M. Eeynoso has given the following process as 
a read}^ means of preparing antimoniate of pot- 
ash. Eecently precipitated hydrated oxide of 
antimony is dissolved in a solution of caustic 
potash, and permanganate of potash then added 
as long as the color is destroyed. When a faint 
rose color becomes permanently perceptible, the 
liquid is filtered, and may in that state be used 
as a test for soda. 



The Aural and Ophthalmic Clinic, at the How- 
ard Hospital, 1812 Lombard street, will take 
place hereafter every Tuesday and Thursday, 
at one o'clock P. M., where clinical lectures 
will be delivered by Dr. Turnbull. 



Leidy's Anatomy. — We have received a copy 
of Leidy's Anatomy, published by J. B. Lip- 
pincott & Co. In elegant typography, and gene- 
ral style, the work has not been exceeded by 
anything in a medical way in this country. 



104 



ANSWERS TO COEEESPONDENTS. 



Vol. V. No. 4. 



The Health of the Miner. — Recent deductions 
from tables, showing the duration of the life of 
the miner, prove that, at the age of 20, miners 
experience an average of 46 per cent, of sick- 
ness more than the general class ; at the age of 
30, they show 70 per cent. ; at 40 years, 78 per 
cent. ; at 50 years, 76 per cent. ; and at 60 
years, 53 per cent. — more than the ordinary 
class of lives. It has been ascertained that, in 
Cornwall, 61 per cent, of the miners die of dis- 
eases of the chest, and only 31 per cent, of the 
rest of the population. — Lancet. 



S. C. G., 3Iiss. — You can obtain Dr. Holmes' ad- 
dress through David Clapp, publisher, 184 Wash- 
ington street, Boston, Mass. Price 25 cents 

J. M. and other Subscribers. — We do not pay the 
postage on the Reporter. If prepaid at the office 
where the Reporter is received, the postage is 26 
cents per annum. This does not include carrier's 
fee in cities, which is extra. But it is optional with 
every one to call at the post-office for his number, 
or to have it brouo;:ht by carrier. 

Br. D. 0. C, Pa. — The usual dose of chloride of 
propylamime in an attack of acute rheumatism is 
from 2 to 3 grains repeated every two or three 
hours. As far as we can learn, the remedy has not 
been used very recently in the Pennsylvania Hos- 
pital. 

D. H. — The only efficient treatment which can 
now be resorted to, is to re-divide the hamstring 
tendons at a point above the cicatrices of the first 
division, and then make extension of the leg suffi- 
ciently violent to break the impediments to straight- 
ening the limb which exist in the joint. A straight 
splint, well padded, should then be applied, and 
passive motion may, after inflammatory symptoms 
subside, be cautiously made. Great success has 
followed such treatment in a number of cases re- 
corded in this journal. 

K.N. — The pleasant tasted worm confections 
which are popularly used, owe their efficacy un- 
doubtedly to Santouine. 

W. P. C. — There was a prevalent opinion among 
the country people, before the time of Jenner, that 
the cowpox, as accidentally taken by those who 
milked cows, insured an immunity from smallpox. 
The attention of .Jenner was thus directed to the 
subject, which led to his final determination of the 
protective power of vaccination. 

Student — Tickets lor the clinical course at the 
Philadelphia Hospital may be procured, without 
charge, by all matriculated students, by applying at 
the city office of the hospital, No. 42 North Seventh 
street. 

The New Sydenham Society.— In answer to sev- 
eral inquiries made by subscribers in reference to 
the new Sydenham publications, we give the follow- 
ing information, communicated by Dr. Richard J. 
DuNGLisoN, Hon. Local Secretary of the Soc ety in 
this city : 

The subscription per annum is a guinea, or five 
doUars and 25 cts. in our money, to which about a 
dollar a year will be added for duty, etc. I can 
hardly tell as yet what the exact amount will be, 



but I think the annual amount will be about six dol- 
lars and a half. The ? orks Avill come to me, and I 
shall take care that th^y are properly distribute'-". 

I have a few copies of the series for 1859 to dis- 
pose of to members, at six dollars and a half for th j 
series of five numbers. 

Richard J. Dunglison, 

121 South Tenth st. 

MARRIAGES. 

AsHTON — Brown. — At Washington City, on 25th 
Sept., by the Rev. J. C. Lee, Dr." W. E Ashton, of 
Washington City, and Miss Ella V. Brown, of Phila- 
delpnia. 

BuRGiN — Sheppard. — At Pittsgrove, N. J., on the j 
18th inst., by the Rev. D. Kelsay, John H. Burgin, ! 
M. D., of Philadelphia, to Ruth B. Sheppard, of 
Pittsgrove, Salem county, N. J. 

Bromwell — Evans — At I^indenwood, Cecil 
county, on the 17th inst,, by the Rev. Mr. Squier, 
Dr. R. E. Bromwell to Miss Josephine Evans, daugh- 
ter of L. H. Evans, Esq. 



DEATHS. 

Holmes — Died at Montreal, C. W., on the 9th 
inst., Andrew Ferdinando Holmes, M. D., LL. D., 
Professor of the Principles and Practice of Medi- 
cine in the University of McGill College, and Dean 
of the Faculty of Medicine, in his 68d year. 

For a few days before his decease, he complained 
of a constriction of the chest, which he compared, 
to a friend, as like an attack of angina pectoris ; and 
on Monday afternoon, on his way to the new college 
building, whither he was going to look after certain 
arrangements, he experienced that sensation chiefly 
while walking against the wind, which was blowing 
rather strongly, although he did not feel it after 
ascending a pair of stairs. On the following day, 
Tuesday, the 9th, he attended to his duties as usual, 
complaining of little else than a want of appetite, 
arising out of the continuance of the same sensa- 
tions. He returned home from an evening visit 
about 7 P. M., and, while writing out notes to the 
members of the Faculty for attendance at a meeting 
which he intended to have held at 3 P. M. the fol- 
lowing day, he was observed by his wife to drop 
his head on his hands, his elbows resting on the 
table, and, without replying to the question put to 
him, " if he felt unwell," dropped from his chair 
dead. 

An autopsy was held forty-three hours after 
death. The brain was healthy, with the exception 
of a general turgescence of the blood-vessels, and a 
rather increased amount of serosity. The chief ab- 
normal appearance here presented was a thickened 
condition of the arachnoid at the vertex, indicative 
of an old-standing, sub-acute, inflammatory aff'ec- 
tion. About fifteen years ago, it is to be observed, 
he sufi'ered intensely from headaches. The thoracic 
viscera were healthy, with the exception of the heart, 
which was rather larger than usual, but not morbidly 
so, and showed evidence of atheromatous degene- 
ration, not to any marked extent. The abdominal 
viscera were perfectly healthy. In fact, we have never 
examined a body whose viscera were in a more 
healthy-looking condition generally. 

A meeting of the members of the Faculty took ' 



October 27, 1860. 



COMMUNICATIONS EECEIVED. 



105 



place on the evening of the 11th, when it was resolved 
' that a letter of condolence should be transmitted to 
the widow and family, and that the members should 
wear mourning for a period of a month, in memory 
of their deceased colleague. 



Died at his residence in Allentown, Pennsylvania, 
Dr. C. H. Martin, aged fifty-three years. 

The subject of this notice was one whose loss 
will be deeply felt by the community in which he 
,' lived, and to which he gave the whole of his useful 
' life. 

Without any eflFort to appear superior to those 
around him in the knowledge of his profession, or 
any real de?ire to be so considered, it will not be 
' denied by any one here, that his death has created 
a vacancy that will not be speedily tilled. The son 
of one of the most eminent and successful physi- 
cians in this district, he had, in early life, the ad- 
' vantages of that thorough familiarity with the prac- 
tical part of his favorite profession, which is so 
indispensable to all who would pursue it successfully, 
so that when he graduated — which he did with the 
highest honors at the University of Pennsylvania in 
I the spring of 1830 — he was able at onec to enter on 
, the active duties of a profession which pre-eminent- 
ly requires a practical training. From that day 
I till the day of his death — for he died in the zenith 
of his practice — his devotion to duty was unflagging. 
I His position among his professional brethren may 
, be known by the fact, that in all difficult cases 
I that occurred in this region, for miles around, he 
! was ever the first that was consulted by them, 
I There was neither cowardice nor timidity in his 

' character, when duty was to be discharged ; no 
I shrinking from personal danger when, by meeting 
it, he could add to his store of medical knowledge. 
When the Asiastic cholera first appeared in this 
country, after having swept the Old World, as with 
a " besom of destruction," he was one of the first to 
meet it. 
; When this terrible disease was raging in Phila- 

1 delphia, and the temporary hospitals erected there 
; were filled with the sick and dying victims of, this 
fell destrvtyer. Dr. Martin voluntarily left his safe 
I and comfortable country home, and spent days and 
weeks in the Southwark and Moyamensing hospi- 
tals, that he might become familiar with a pesti- 
lence which threatened to meet him soon among 
his own friends and neighbors. 

But he is gone now ! and the places that knew 
him will know him no more ! His cheerful confi- 
dence and ready skill will be missed by his nume- 
rous patients, none of whom will ever lorget him ! 

His life was useful and prosperous, his death sud- 
den, and to all, but himself and his confidential 
friends, most unexpected. Neuralgia of the heart 
was the disease that closed his earthly career. 
I The train that followed his body to the grave 

evinced how universally his loss was felt. 

Be died on the 25th of September, 1860, aged 53 
years 1 month and 10 days, leaving a widow and 
five children to lament his sudden death. 
" Peace to his remains!" 



Communications Received. — Canada West, Dr. 
John Salmon, (with end.) — Connecticut, Dr. N. Brig- 



ham, (with end.) — Georgia, Dr. D. Richardson, 
(with end.) — Iowa, Dr. M. Marbourg, (with end } 
Drs. Williamson & Thrall, (with end.) Dr. J. Kerr, 
(with end.) — Louisaina, Dr. G. W. Dirmeyer — New 
York, Dr. J. Malone, Dr. D Holmes, (with end. for 
Dr. W. P. Randall,) Dr. Mac Nicholl, (2,) Dr C T. 
Chase, (with end.) Dr. J. S.Young, (with end.) Dr. 
G. V. Newcomb, (with end.) Dr. R. M. Buell (with 
end.) Dr. B. Fincke, (with end.) D. F. Morris (with 
end.) Dr. C. Valentiny, (with end.) Dr. T. Keily, 
(with end.) Dr. J. Maloue, (with end ) Dr. B. J. 
Stow, (with end.) Dr. W. Hutcheson, (with end.) 
Dr. T. H. Frankum, (with end.) Dr. R. S. Olmstead, 
(with end.) Dr. D. E. Smith, (with end.) Dr. W. A. 
Hall, (with end.) Dr. H. A. Archer, (with end.) 
Dr. T. M. Ingram, (with end.) Dr. J. H. Talmadge, 
(with end.) Dr. E. M. Chapman, (with end.) Dr. 
D. PfeiflFer, (with end.) Dr. F. W. Gosling, (with 
end.) Dr. C. L. Mitchell, (with end.) Dr. F. Bond, 
(with end.) Dr. C. W. Bates, (with end.) Dr. G. 
Higgins, (with end.) Dr. T. T. White, (with end.) 
Dr. T. Nichols, (with end.) Dr. C. Schieferdecker, 
(with end.) Dr. W. H. Hanford, (with end.) Dr. A. 
Wright, (with end.) Dr, W. Mac Kenna, (with end.) 
Dr. A. is. Jacobson, (with end.) Dr. J. Seigh, (with 
end.) Dr. .J. Mayer, (with end.) Dr. Saltsveil, (with 
end.) Dr. Wittman, (with end.) Dr J. A. Brady, 
(with end.) Dr. N. L. North, (with end.) Dr. 0. H. 
Smith, (with end.) Dr. R. H. Hinraan, (with end.) 
Dr. S. Ely, (with end.) Dr. P. M. Barclay, (with 
end.) Dr. C- Dunham, (with end.) Dr. S. C. 
Church, Dr. E. Peck, (with end.) Dr. W. Jones, 
(with end.) Dr. Gippert, (with end.) Dr. S. Wig- 
gins, (with end.) Dr. A. Deyo, (with end.) Dr, R. 
V, Montfort, (with end.) Dr, J. Thompson, (with 
end.) Dr. D. Willcocks, (with end.) Dr. J. Vanda- 
veer, (with end.) — New Jersey, Dr. W. A. Durrie, 
(with end.) Dr. Elder, (with ench) Dr. Kudlick, 
(with end ) Dr. R. Chabert, (with end.) Dr. G. Sal- 
tonstall, (with end.) Dr. J. Quidor, (with end.) Dr. 
Kopctshny, (with end.) Dr. J. N. Quimby, (with 
end.) Dr. Max Kuechler, Dr. J. Kollock — North 
Carolina, Dr. W. T. Sutton— O/izo, Dr. W. E. Chap- 
man — Pennsylvania, Dr. W. F. Trout, Dr. T. Has- 
son, Dr. C. Herrington, Dr, H. Umstad, (with end.) 
Dr. A. G, McCandless, (with end.) Drs. S. S. & R. 
Wallace, (with end.) Dr. A. Markley, Dr. J. A. 
Reed, (with end.) Dr. B. Shannon, (with end.) Dr. 
J, Burkhold, (with end.) Dr, G, A, Burke, Dr. J. 
C. Shivner, (with end.) Dr. J. F. Treichler, (with 
end.) Dr. C, H. Smith, (with end.) Dr. R. H. Awl, 
(with end.) Dr. F. L, Haupt, (with end.) Dr. E. R. 
Dodge, (with end.) Dr. D. W. Shindle, (with end.) 
Dr. J. B. Newbaker, (with end.) Dr. E. Franciscus, 
(with end.) Dr. U. Q. Davis, (with end.) Dr. Jas. 
S. Dougal, (with end.) Dr. P. B. Mish, (with end.) 
Dr. H. D. Hun.er, (with end.) Dr. J. H. Harley, 
(with end.) Dr. T. H. Wilson, (with end.) Dr. W. 
Hayes, (with end.) Dr, W. Leiser, (with end.) Mr. 
John Hulme, 

Office Payments.— Dy. J. H, Keeler, (Pa.) Dr. C. 
Bombaugh, (Pa.) Dr. Asche, Dr. J. G. Koehler, (Pa.) 
Dr. Martin, (N. J.) Dr. J. B. Irwin, (N. J.) Dr. J. 
Flynn, C. A. Pyatt, Dr. Gobrecht, Dr. J, Grigg, (N. 
J.) By Mr. Swaine : Mrs. Dr. McClenachan, and 
Dr. J. B. Flagg. By Mr, Foster : S. Stewart, L. 
H. Pease, T. M. Drown, E. W. Keller, and T. N. 
Lewis, Dr. G. Hamilton. 



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THE 



MEDICAL AND SURGICAL REPORTER. 



WHOLE SEKIES, 
NO. 211. 



NEW SEEIEF, 



} PHILADELPHIA, NOVEMBER 3, 1860. { yoIyTo5 



OmcmAL DEPARTED! EPIT. 

COMMUNICATIONS. 

Veratrum Viride ; its Physiological and The- 
rapeutical Action. 

By B. Woodward, M. D., 

Of Galesburg, 111. 
Within a few years past, veratrum viride lias 
come into pretty general use as an arterial se- 
dative, and its merits are being acknowledged 
as such. As a general thing, its use has been 
confined to strictly inflammatory diseases, 
though I think it will be found, on trial, to be 
much more extendedly useful as a therapeutic 
agent. From a somewhat attentive watching 
of its effects in all the cases in which I have 
used the article, I am led to believe that its sole 
action is upon and through the nervous system, 
and that, unlike antimony, it has no effect upon 
the blood. Were its action upon the blood, we 
should see its effects after its primary action 
has passed off, which is not the case. There is 
I no remaining depression, as with antimony ; 
. neither is the nausea and vomiting, nor its ca- 
i thartic action, permanent. I have never seen 
£ it produce watery stools, neither have I ever 
I known it to produce those peculiar ejections and 
dejections of the secretions of the stomach and 
bowels, which are often found so troublesome 
where antimony has been exhibited. I regard 
it as solely a nervous sedative, and in no case a 
stimulant. I propose, in the present paper, to 
establish, if I may, the truth of my proposition, 
by reference to cases of disease in which I have 
used the remedy. 

The researches of Bernard and others are 
opening up a new field in pathology and thera- 
peutics, and, if their views of the agency of the 
nervous system shall stand the severe test to 



which they will be subjected, we shall have a 
new therapeia. Many articles, which have been 
hitherto used empirically, will be used ra- 
tionally, while others will go out of use in cer- 
tain cases, and more rational remedies and 
modes of treatment will take their places. Thus 
another step will be taken toward making 
medicine an " exact science.'^ 

If the action of veratrum viride is upon the 
nervous system, upon what nerves does it spe- 
cially act? is an important question, with a 
view to its therapeutic use. We must judge of 
this by its effects. 

As soon as the system comes under its influ- 
ence, the first phenomenon is a reduction in 
the frequency of the pulse. The next is a 
diminution of the frequency of the respiration. 
Carry it a little further, and you have a sense of 
sinking or general prostration, referred by the 
patient to the heart. " Jimmy, how did you feel 
after taking the medicine last night V was a 
question I put to an Irishman a short time ago, 
who was sick with one of our mixed fevers — 
bilious remittent and typhoid together. There 
had been no laxity of the bowels — on the con- 
trary, it was hard to move them ; his urine had 
been very scanty ; tongue dry, with a brown 
coat — no redness of tip or edges. His pulse 
ranged from 110 to 125, and had been so for five 
days ; constant disposition to talk, though ra- 
tional. I had used the veratrum viride in the 
ordinary doses without eflect ; I could not 
rouse the secretions, and quinine did no good ; 
I had just put him on ten-drop doses of Til- 
den's fld. extract of veratrum viride, to be 
repeated every three hours till he vomited ; I 
was determined to give the veratrum a thorough 
trial ; this was done two hours after taking the 
last dose — 

" Och, docthur, the medicine made me very 
sick intirely ; my heart did not go right at all, 
and shure I cuddent breathe, and I thought it 
was all over wid me, and pretty soon I womited, 
and then the sweat came out all over me, and 
107 



108 



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Vol. V. No. 5. 



shure I made a power of watlier, and soon I 
had to get up and my bowels passed off, and I 
have just got back to bed, and indade I feel a 
heap better.^' 

His pulse was now but 45 per minute, soft 
and full ; he was perspiring freely. From that 
time he had no more fever ; quinine acted well ; 
the pulse was kept down to 70 by the use of 
small doses of veratrum, and he speedily got 
well. This ignorant Irishman, who knew no 
more about the nervous system, or the circula- 
tion, than a Hottentot, had given me a rational 
account of the action of the remedy on his ner- 
vous system. He had traced every thing di- 
rectly to the pneumogastric. When the ner- 
vous irritation, which kept up the pulse and 
locked up the secretions, was controlled by the 
sedative, he vomited ; his kidneys and skin 
acted, and his bowels moved — the circulation 
being held in abeyance all else was enabled to 
go on harmoniously. In typhoid fevers, when 
the pulse is rapid and feeble, we always have 
evidence of nervous irritation, calling for a 
sedative.* 

Some months since, in one of your hospital 
reports, I was surprised to see the use of vera- 
trum condemned in typhoid fever, on the 
ground " that we had already a weak, feeble 
pulse, and the veratrum would only make it 
weaker." It is not pleasant to disagree with 
high professional authority ; but, as searchers 
after truth, we are obliged to make our own 
observations and deductions. It has appeared 
to me that a wrong view of the action of vera- 
trum was here taken, and also a wrong view of 
the condition of the system which produced this 
rapid feeble pulse. All the symptoms seem to 
j)oint to an unnaturally excited and irritated 
state of the nervous system. The secretions are 
locked up ; the brain is oppressed ; the heart 
and lungs are laboring to free themselves from 
the tension to which they were subjected. Now 
here is a condition in which remedies cannot 
act ; but, if we can subdue this nervous exalta- 
tion, the system becomes relaxed, the secre- 
tions are restored, the circulation and respira- 
tion become slower, fuller, and stronger, the 
lungs oxygenate the blood more completely, 
and nutrition and depuration, which had before 
been impossible, allowed to go on. I would not 
claim that veratrum, or any other remedy, will 
cut short a typhoid fever, but that its use will 



* This treatment is perfectly consonant with the propriety of 
sustaining tiie system with food, which I think is vitally im- 
portant in the treatment of typhoid fever. 



prevent the system from wearing itself out by 
its own tension. 

In pneumonia and pleurisy, it acts by depress- 
ing the nervous action which concentrates the 
blood on the lungs and pleura. It may be that 
the drug in question will not in every case do 
away with the use of the lancet, but I can say, 
from my own experience, that in neither of the 
above diseases have I felt called upon to bleed 
since I learned the value of veratrum. In pleu- 
risy I give as large a dose at first as I think the 
patient can bear, and bring the pulse down 
as rapidly as possible, and keep it there, and I 
have found no trouble from subsequent effu- 
sions — not that this is my only remedy in these 
cases, but that it precedes and prepares the 
way for others. 

In three cases of puerperal fever I have 
been governed by these views, and have pre- 
mised all other treatment by controlling the 
pulse with veratrum ; then opium comes in 
with far better effect than without it. In a late 
case of puerperal convulsions, I did not resort to 
veratrum, but used the lancet twice, taking 
away forty-five ounces of blood before the 
convulsions ceased ; but, in about four hours 
after the last convulsion, the lady became 
furiously delirious, requiring to be held on 
the bed ; two doses of ten drops each of Nor- 
wood's tr. verat. quieted her so completely that 
she slept for four hours, and had no return of 
the delirium. Eeasoning from the action of the 
remedy on the nervous system, I have deter- 
mined to try its effects in the first case of deli- 
rium tremens which shall come into my hands. 

There is one other most terrible disease, for 
which, as yet, no remedy has been found, in 
which I advise a thorough trial of veratrum — 
hydrophobia. Here it can but fail, and if it does, 
no harm can be done. In this disease the ner- 
vous system is in a terrible state of irritation. 
It may be that the convulsions can be controlled 
by this powerful sedative. Dr. Atlee's case of 
puerperal mania, in Eeporter for Oct. 6th, leads 
me to believe that the remedy may be used suc- 
cessfully in puerperal convulsions ; and, if in 
these convulsions, why not in hydrophobia? 
If puerperal convulsions are caused by uraemia, 
as is claimed, why are they controlled by vene- 
section ? The remaining blood is as truly poi- 
soned as before venesection. The fact that there 
is either arrest of urinary secretion or albumi- 
nuria, does not prove to my mind that the con- 
dition causes the disease ; but the phenomena 
of the disease lead me rather to believe that the 



November 3, I860.] 



COMMUNICATIONS. 



109 



disease causes tlie condition, and that tlie dis- 
ease is one of purely nervous origin. If the 
nervous and circulatory systems are the great 
sources of life, they must also be of death, and 
if of death, then of disease. If we can get 
them right, we cut short disease. 

There is one other form of nervous disease 
in which I have lately used the veratrum with 
the best effects. I was sent for, to see a little 
girl, eight years old, who, while recovering 
from scarlatina, and while desquamation was 
going on, went to an open door for a few 
minutes. She soon complained of pain in the 
right thigh and leg, which became so severe, 
that she got no rest, day or night. I found the 
pain entirely characteristic of neuralgia, follow- 
ing the track of the sciatic nerve from its exit, 
from the pelvis, through its ramification, to the 
foot. Her -pulse was 110, tongue dry, but clean, 
without redness. She had not urinated for 
forty-eight hours, bladder full, rising to the 
umbilicus, suffering much from this cause. I 
drew off with the catheter two quarts of highly 
ammoniacal urine, and put her on morphia 
and tinct. conium. I found her the next day 
in the same condition, bladder full, and the 
pain now in both limbs. The morphia had 
produced no relief, her pulse was now 120. 
Moved her bowels with enema, and put her on 
quinia, grs. iij., morphia, I gr. every four hours. 
This gave no relief, as I found her the next 
day fully as bad, in every respect, as she had 
been ; drew off the urine again, and put her on 
veratr. nr. four drops every four hours, till the 
pulse was brought down to 60; she had no 
more of the pain, or retention of urine, the 
pulse was kept from rising above 80 by small 
doses of the veratrum for a few days, and she 
made a good recovery. I have been thus pro- 
lix in the detail of this case, because it illus- 
trates the effects of the remedy on the nervous 
system. 

Though the drug seems to have a more 
controlling influence over the pneumogastric 
nerve, its good effects are seen in the general 
nervous system. Another case of neuralgia 
occurred to me, in which the veratrum seemed 
to have a controlling influence. It was the case 
of a lady who, for nine weeks, had been treated 
by judicious physicians without the least relief. 
In her case, it was the crural nerve which was 
affected throughout its whole ramifications, 
over the pubic region, the labia, and inside of 
the thigh. Opium, blistering, the endermic use 
of veratria, aconite, etc., had been faithfully 



tried, but without effect. It was not without 
many misgivings that I undertook her treat- 
ment. During the paroxysms, there was a re- 
markable acceleration of the pulse, and a 
general nervous irritability. She was put on 
tr. veratrum viride, at first eight drops, and in 
four hours four drops ; this brought the pulse 
down to 50 per minute, with a marked amelio- 
ration of the pain. She then took twenty drops 
of Tilden's fld. ext. of conium every eight hours, 
with four drops of the veratrum between each 
dose of the conium. In this way, the pulse was 
kept down to 70 per minute for several days, 
during which time there was no return of the 
pain. She was then put on R. quinise, 9ij., 
ext. conii, gj. In pil. no xxx div. Two pills to 
be taken three times a day. Before she had 
half got through the course, the cure was per- 
fect, and there has been no return of the pain, 
now eight months. The only material differ- 
ence in the treatment was the use of the vera- 
trum, and I cannot but conclude that this was 
the efficient remedy. 

Have I made out my case — "that vera- 
trum viride is purely a nervous sedative ?'' 
At the risk of being thought a " hobby rider," 
I believe that the day is not far distant when, 
in extent of range as a therapeutic agent, vera- 
trum will rank with opium. 

When we wish to get the nervous system 
well under the influence of the remedy, it is 
best to give as large a dose at first as will be 
well borne. The remedy is not like digitalis, 
accumulative in its action. Vomiting will not 
occur till the circulation is brought well down, 
and when this does occur, it is only a sign that 
the system is well under the influence of the 
drug, and in no case proves troublesome ; a 
teaspoonful of brandy, or a few drops of tr. 
opii will arrest it at once. 

Wishing to know, from my own experi- 
ence, what the physiological effects of vera- 
trum were, I subjected myself to the experi- 
ment. I will premise, that I am nearly fifty 
years old, of a very nervous temperament, 
the natural rate of my pulse is 90, respira- 
tion twenty per minute ; ordinary weight, 
115 pounds ; have no constitutional disease. I 
give my own condition, because, in endeavoring 
to ascertain the physiological effects of a medi- 
cine, it is important to take into account the 
physiological condition of the person experi- 
mented upon. At 8 P. M., after a busy day in 
my profession, I took eight drops of Nor- 
wood's tinct. verat. vir., pulse 94. In one hour, 



1 



110 



COMMUNICATIONS. 



Vol. V. No. 5. 



pulse 87, respiration 18 ; at 10 o'clock, pulse 
80, respiration 16 ; took now four drops 
of the tinct. ; at 11 o'clock, pulse 75, and res- 
piration 14; felt a degree of lassitude, with 
a disposition to inflate the lungs very fully ; at 
12 o'clock, pulse 65, with a sense of sinking 
about the heart; respiration 12. I now 
took three drops more ; in ten minutes felt 
nausea, pulse 50, respiration 8 ; in fifteen 
minutes more I vomited, pulse 42, respiration 
6 ; had profuse diaphoresis and sense of utter 
' prostration. I now took a teaspoonful of brandy, 
and in ten minutes, another ; in half an hour, 
the pulse was 50, respiration 9. Took an- 
other teaspoonful of brandy ; in twenty minutes, 
pulse 56, and respiration 11 ; in two hours 
from this time, the pulse was 67, respiration 
14. I now went to bed, and slept well for 
six hours. When I awoke, it was with a most 
delightful sense of relaxation and rest; ate a 
hearty late breakfast, and went to my business 
as usual. Through the rest of the day, felt 
rather weak, but by night had entirely reco- 
vered from the effects of the drug. I thought 
I now understood the action of the medicine 
upon the heart and lungs. At no time did the 
brain seem to be affected, except that toward 
the last, there was a species of torpor, and my 
ideas were not very clear. I fear, Messrs. Edi- 
tors, that your readers will think that I am 
still under the influence of veratrum viride. 



Poisoning by Atropine. 

By Max Ktjechler, M. D., 

Of Newark, N. J. 

Several cases of poisoning by atropia have of 
late been recorded. The powerful action of this 
alkaloid, externally applied for the purpose of 
dilating the pupil or of promoting the absorp- 
tion of exudations in the layers of the cornea, 
has led the profession to abandon belladonna 
almost entirely. For weeks a strong solution, 
for instance gr. vi, x, to aq. ^i, maybe dropped 
into the eye 10 to 20 times a day, and never has 
it been followed by other symptoms, except 
dilatation of the pupil, resorption of exuda- 
tions ; only after a very prolonged use has in- 
jection of the conjunctival vessels been ob- 
served, terminating, if the use of the article is 
persisted in, in conjunctivitis. 

Accidentally, however, it happened several 
times within the last few years that solutions of 



atropine, prescribed for external use, were given 
internally. 

The symptoms of three cases to which I can 
refer are remarkably similar. One is recorded 
by Dr. Samuelson, in the Koenigsberger Med. 
Jahrbiicher, 1858 ; i, 1 and 2 ; the second case 
occurred under the hands of Desmarres, at 
Paris, in 1856, and was treated in the Charite, 
at Berlin, where I had the opportunity to ob- 
serve the case; the third case occurred in my 
private practice in 1857. 

Dr. Samuelson has described the first case as 
follows : 

The patient, who had taken about i or f of 
sulphate of atropia, lay in a deep soporous 
sleep, from ^which he could be roused neither 
by loud talking, nor by shaking him, nor by 
applying irritants to the skin. The face was 
almost of a purple color ; the conjunctiva great- 
ly injected ; the cervical veins full ; the tempe- 
rature of the skin considerably elevated ; a 
pearly sweat upon the forehead and temples. 
The pulse, at' first 88, became irregularly and 
strongly accelerated (130, 140;) respiration 
slow and labored ; power of deglutition almost 
entirely gone. The pupil, which is very strange^ 
was not dilated. In spite of leeching, venesec- 
tion, bladders filled with ice, applied to the 
head, injections of vinegar, etc., the symptoms 
kept on increasing in violence, the pulse be- 
came more frequent and irregular, occasionally 
groups of muscles were afiected with tonic 
spasm, and the pupil assumed an oval form. 

Six hours and a half after the commencement 
of the narcosis the patient awoke from his sopor, 
and was perfectly conscious. Dr. Samuelson 
remarks, very properly, that while, in chronic 
toxication by belladonna, the frequency of the 
pulse is at first lessened, the pupil dilated, and 
the sensation of dryness and dysphagia precede 
the slowly developing symptoms of cerebral de- 
pression, — in acute poisoning by atropia we 
have, after a very short stage of dysphagia, a 
marked degree of sopor, followed by rapid loss 
of consciousness, increased frequency of the 
pulse, tetanic spasms, and tremor of the hands. 
At least two hours are necessary before the in- 
toxication passes off, but it may continue for 
eight hours after the administration of the re- 
medy. Half a grain may kill an adult. 


The art of healing must always depend, in 
part, upon empirical observation, and in part 
upon inductive science. But in both alike, the I 
physician is, or should be, " naturas minister et ! 
interpres." — Hartshorne^s Medical Principles. 



November 3, 1860. 



COMMUNICATIONS. 



Ill 



Case of Supposed Spider Bite, followed by 
Severe Symptoms, Rigidity of tlie Mus- 
cles, Prostration, etc. 

By D. Thompson, M. D., 

Of Castalian Springs, Tenn. 

On August 29th, 1860, I was called to see a 
man at the hour of 6 A. M. He was possessed 
of an unusually large frame ; 38 years of age. 
When I arrived, he reported to me that he had 
been out at his barn about ten hours before, 
when he felt something bite or sting him about 
midway on the inner side of the left thigh ; the 
sensation, he said, bore some similarity to a 
bee's sting. He slapped his hand on it, and 
again experienced the same sensation as before, 
near the same locality. Having no light he 
made no examination, and paid no particular 
attention to it. 

On examining him, I found the wounds to be 
but little more than a flea's bites, the size of 
half a dollar, with a deep red spot in the mid- 
dle, and red purplish color extending to the 
circumference. The pain increased, and ex- 
tended up his body, until it arrived as high as 
his heart, so he informed me ; it then became 
more general through his body ; it came on 
paroxysmally in severity, and was so intense at 
times that, in fact, I do not think that I have 
ever seen a person apparently in more misery 
and agony. 

In addition to this, the muscles of the abdo- 
men were tense and hard, rigidly contracted ; 
his diaphragm, likewise, was much contracted, 
making him appear as if belted tightly around 
the body ; his respiration was, in consequence, 
much oppressed. His pulse was slow, 42 
beats per minute ; extremities cold, up to the 
knees and elbows, even above them ; his whole 
surface bedewed with a clammy and cold per- 
spiration. The two bites were in close proximity 
to each other. 

Treatment. — There were three prominent 
therapeutical indications in this case, viz : first, 
allay pain ; 2d, revive the circulation ; 3d, sub- 
due the rigidity and contraction of the muscles. 
The first indication was met by opiates, to 
which the family urged objections, on account 
of his unusual susceptibility to their bad in- 
fluence. Believing, however, that it would ex- 
pend its force upon the pain, instead of mani- 
festing its unhappy eff'ects, I felt no hesitancy 
in giving it. 



He took i gr. morphia sulph. without 
any efi'ects following it. The same quantity 
was given in succession every f of an hour, 
until he had taken his fourth dose. I then 
gave him 25 drops of tr. opii. every hour. At 
10 o'clock the pain was, to some extent, 
mitigated. Shortly after the first dose of mor- 
phia had been administered, a half glass of 
good whisky was given, and a few minutes 
later a teaspoonful of spirits of camphor ; fol- 
lowed in I of an hour by a teaspoonful of spts. 
of ammonia. Under the continued use of the 
above stimulants there was an apparent reac- 
tion. But as there was still difiiculty of respi- 
ration and the contracted state of the muscles, 
my object was to administer some medicine 
which combined in its actions both a stimula- 
ting and antispasmodic effect. Hence I re- 
sorted to the use of the ammoniated tincture of 
valerian, the success of which was highly gra- 
tifying. This treatment was continued up to 4 
o'clock P. M., with a general amelioration of 
all symptoms. I then directed the suspension 
of the medicines, ordering the stimulants to be 
given freely, if he should get worse, enjoined 
the recumbent position, and left him. But an 
hour or so after leaving, he felt so much better 
that he was injudicious enough to get up from 
his bed, and soon became worse. On taking a 
few glasses of whisky and few teaspoonsful of 
ammoniated tincture of valerian he was re- 
lieved again ; and what was remarkably 
strange, the whisky had not the least intoxi- 
cating effect upon him. I saw him again on the 
same day at 8 o'clock P. M., and remained all 
night with him — forcing him, against his will, to 
take the stimulants frequently and constantly — 
when he felt any returning symptoms. I left 
next morning at 8 o'clock, directing the con- 
tinual use of stimulants. When I returned on 
the 31st, the pain had descended to the left 
lower extremity which was bitten, and he soon 
recovered entirely. 



The first traces of field hospitals, or, as they 
are called, flying hospitals, occur, perhaps, in the 
East. At any rate, the Emperors Maurisius and 
Leo the Sixth had along with their armies cer- 
tain followers termed dejmtati, who were dis- 
tributed among the cavalry, and were obliged 
to carry off" those who were wounded in battle. 
On this account, they had on the left side of the 
saddle two stirrups, in order that they might 
more easily take up the wounded behind them ; 
and for every person thus saved they obtained 
a certain reward. They were obliged, also, to 
carry with them a bottle containing water for 
the purpose of reviving those who might have 
fainted from the loss of blood. — Outlines of Mili- 
tary Surgery. 



112 



HOSPITAL PEACTICE. 



Vol. V. No. 5. 



Illustrutinns of Jnspital frartia. 

PENNSYLVANIA HOSPITAL. 

Service of Dr. J. Forsyth Meigs. 
DELIRIUM TREMENS. 

At tlie conclusion of his service on Wednes- 
day last, Dr. Meigs made some remarks on the 
nature and treatment of delirium tremens, a 
disease which has recently again excited much 
attention. Dr. Meigs mentioned two cases, 
which he had seen, of persons that had died 
rather suddenly during attacks of delirium tre- 
m.ens; and, in both instances, the right heart 
was found filled with blood-clots, of great firm- 
ness and whitish-yellow color, indicating that 
they must have formed some time before death. 
It is often supposed that blood-clots, formed 
before death in the heart, always occur in 
cases where the death-struggle has been pro- 
tracted. Yet, in both these instances, the death- 
struggle was short, while the character, con- 
sistence, and color of the clot left no doubt that 
it had been some considerable time in forma- 
tion. These observations, taken in connection 
with experiments recently made upon animals, 
by various continental observers, seem to show 
that sudden death in delirium tremens arises 
from blood coagula in the heart, and that 
chronic alcoholism, or alcoholic poisoning, has 
a tendency to lead to coagulation of the blood. 
In the experiments alluded to, the injection of 
alcohol into the cellular tissue and the veins 
was followed by clot-formation in the heart. 
Another remarkable circumstance is, that these 
clots were found in the right heart, blocking up, 
in one case, the whole ostium venosum, while, 
in ordinary cases, coagula in the heart are 
generally in the left side of the heart. 

In reference to the question of the true nature 
of delirium tremens, the oldest theory of phre- 
nitis is, of course, abandoned at present. An- 
other opinion is still prevailing to some extent, 
namely, that it arises from a peculiar irritation 
of the brain, in consequence of a sudden with- 
drawal of stimulants. This theory, however, 
is not tenable, as it has been shown to be un- 
supported by the statistics. It is true, when 
persons are attacked by delirium tremens, they 
have often not drank much for three or four 
days previously, but this is owing to the satu- 
ration of the system with the poison, and na- 
ture resisting the further introduction of the 
deleterious agent by the establishing of vomit- 
ing, etc. ; the delirium tremens is not the result 
of a suspension of stimulants, but the latter is 
rather a consequence of the saturation of the 
system by the alcohol, which finally terminates 
in delirium tremens. 

The opinion which seems the most correct, 
and one to which we are led by the opinions of 
some of the best clinical observers, such as 
Laycock, Bennett, Carpenter, etc., is that deli- 



rium tremens is the result of a slow toxkation by 
alcohol. 

With this view of the nature of the disease, 
the indication of treatment is easily given. 
Give nature a chance to eliminate the poison ; 
put the system in the best possible condition 
to resist the toxication and to remove the 
poisonous material. It has been found in ani- 
mals which have died from alcohol poisoning, 
that while the various tissues were impregnated 
more or less with alcohol, the brain showed a 
much larger amount of the toxic agent than 
other tissues ; and, hence. Carpenter concludes 
that there is what he terms a selective affinity 
between alcohol and the brain matter, pro- 
ducing the molecular condition of the cerebral 
substance, the symptoms of which we call de- 
lirium tremens. 

The patient should not be confined to a dark 
small room, nor should he be tied and mana- 
cled, as was generally done formerly. Whole- 
some food, beef tea, milk, etc., are to be given. 
^ The excessive use of opium or alcohol in this 
disease has been found to be injurious. Opium 
should never be given during the day-time, but 
only at night, and then in moderate doses. 

As to alcohol, Laycock and Bennett object 
to it in toto, and, if used at all, it is only in 
cases where the patient is rapidly sinking. 
Many persons attacked with delirium tremens 
are suffering from granular degeneration of the 
kidneys, and ursemic poisoning is superadded, 
from which the patient dies, while he might 
have recovered from the delirium tremens. 



JEFFEESON MEDICAL COLLEGE. 

Service of Prof. Gross. 

Reported by N. G. Blalock, of N. C. 

HYPERTROPHIED TONSILS OPERATION. 

The patient was a young lady, 17 years of age, 
of good general health ; had been suffering with 
chronic enlargement of the tonsils for some 
weeks, which was a source of great inconve- 
nience. The parts are liable to frequent attacks 
of acute inflammation from slight exposure to 
cold ; deglutition is impeded ; the voice is ren- 
dered hoarse, and respiration is noisy and labo- 
rious, especially during sleep. Acute cases may 
be relieved by proper attention to the secretions, 
diet, clothing, and occasional use of the nitrate 
of silver to the afiected parts ; but when the 
disease becomes chronic, and the enlargement 
of such size as to cause much inconvenience, a 
portion should be clipped off. This may be 
done with the tonsilitome ; but usually a suffi- 
cient portion cannot be removed. Professor 
Gross, therefore, prefers the vulsellum and the ' 
probe-pointed bistoury. The surgeon seizes the 
glands with the volsella, (having the tongue 
depressed,) and with the knife clips off a por- 
tion, cutting from below upwards. The opera- , 
tion is simple, and causes but little pain ; some- 
times the hemorrhage is profuse, but is usually 



November 3, 1860. 



MEDICAL SOCIETIES. 



113 



controlled by tlie use of cold water held in the 
mouth and gargled, or by styptics. The patient 
should be careful in regard to exposure, other- 
wise severe inflammation might result. 

This disease most commonly attacks young 
persons of a strumous or scrofulus diathesis, and 
this fact should be borne in mind in the treat- 
ment of the disease. 

ANAL FISTULE. 

The patient, 30 years of age, had been suffer- 
ing from this disease for two years. It was the 
result of an abscess, which was situated in the 
ischio-natal fossa, an inch above the anus. The 
fistula was complete, entering the bowels just 
above the sphincter ani muscle. The action of 
the sphincter and levator ani prevented its clo- 
sure. The only means of relieving this diffi- 
culty perfectly is an operation in which the 
sphincter is divided, thus giving the parts rest. 
Operation. — The patient being placed on his 
knees and elbows on a bed, and the nates being 
kept asunder by an assistant, the surgeon intro- 
duces his fore-finger into the rectum, and, at the 
same time, passes a flexible grooved director 
along the fistule into the rectum, and, with the 
assistance of the finger, the end within the bowel 
is brought out at the anus. Having raised the 
parts on the director, they are to be divided, 
which is done by running a history along the 
groove of the director. We give the patient a 
full anodyne to lock up the bowels, and, also, 
to relieve pain, and apply to the parts the warm 
water dressing, allowing the wound to heal from 
the bottom. 

RANULA. 

The patient, a man 24 years of age, had been 
troubled with a painless tumor under the 
tongue of six weeks' standing, and so large as to 
displace it very much, mechanically obstruct- 
ing his speech. It consisted of an encysted 
tumor, called ranula, from its resemblance to a 
frog's belly under the tongue, caused by the ob- 
struction of the ducts of the sublinqual gland. 
The accumulated saliva forming the tumor, the 
more watery portions of which have escaped, 
leaving a ropy, jelly-like mass. The tumor was 
laid open, and a portion of its lining membrane 
was snipped off", allowing the contents to escape. 
The parts were then brushed over carefully 
with dilute tincture of iodine, with orders to 
have it applied again in two or three days, 
should it become necessary. The object of this 
procedure was to, cause inflammation, with 
effusion of lymph, and, consequently, oblitera- 
tion of the sac. 

WRY NECK — OPERATION. 

The patient was a young lady, 22 years of 
age, who had been suftering with contraction of 



the sterno-cleido mastoid muscle of the right 
side for eleven years. It came on without any 
assignable cause, and an operation had been, 
performed for the relief of the deformity about 
five years ago. The muscle was divided by 
passing a delicate tenotome under the skin, and 
immediately behind the muscle, then by a saw- 
ing motion it was severed with an audible snap, 
leaving an interval between the two divided 
ends. The head then resumed its natural posi- 
tion for the first time in eleven years. There 
will be no apparatus needed here, as in case of 
club-foot. 

We will order the patient a grain of sulphate 
of morphia, and keep her quiet, and on light 
diet. 

RHINOPLASTY. 

The patient, a man of about 40 years of age, 
presented himself at the clinic, suffering with a 
loss of the substance of the nose, requiring for its 
relief an operarion. Some twelve years since, by 
an accidental fall, he received an injury, by 
which the side and a portion of the nasal sep- 
tum was destroyed. He has been in the Col- 
lege Hospital for a week, preparing for the ope- 
ration. Professor Gross removed from the 
forehead sufficient integument for the forma- 
tion of the new nose, and after freshening the 
edges of the cicatrix, united the two cut edges by 
the tongue and groove suture, as it is called, a 
procedure first brought into notice by Dr. Pan- 
coast. The upper flap, being loosened from the 
forehead, was twisted upon itself, brought into 
its new position, and confined by sutures. A 
full dose of morphia was administered to ensure 
the patient's rest, and the wound was dressed 
with the warm water dressing. The result of 
the case will be reported at a subsequent 
period. 



PHILADELPHIA COUNTY MEDICAL 
SOCIETY. 

Reported by Wm. B. Atkinson, M. D., Recording Secretary. 

Wednesday Evening, October 10th. 

Dr. Isaac Eemington, President. 

Subject for Discussion : Opium as a Therapeutic 

Agent. 

(Continued from page 92.) 

Dr. Coates, after complimenting the scientific 
precision and gentlemanly courtesy of the ex- 
perienced lecturer, in his very able and judi- 
cious discourse, could coincide very nearly in 
most, if not all, of the aphorisms which con- 
cluded the discourse. 



114 



MEDICAL SOCIETIES. 



Vol. V. No. 5. 



He begged to make a few remarks of a per- 
sonal nature. The doubts of tbe lecturer, with 
respect to danger from very large doses of 
opium, had recalled to Dr. Coates' mind sun- 
dry charges loudly made against himself, in 
regard to the use of that article in delirium tre- 
mens. He had been charged with depending 
on opium alone, with giving it, in large 
amounts, dose after dose, without limit or 
stint, and even " day after day,-"^ and with con- 
tinuing to repeat that he had never known or 
heard of any harm from it, and that the patient 
must sleep or die ; there was no alternative. 

He was so unfortunate as to be the author, 
in 1824, of a memoir on the subject, which was 
published in the North American Medical and 
Surgical Journal. Grentlemen who would do 
him the honor of referring to that paper would 
easily find how unjust, up to that time, all 
these imputations were. It was necessary, 
however, to discuss two of the propositions just 
recited. One of these was the statement, that 
"the patient must sleep or die; there was no 
alternative.'^ Eeminding gentlemen that he 
was speaking of delirium tremens, and not, as 
had been justly distinguished by a member of 
this body from one of the prisons, of " debauch,'' 
he said that this proposition was, in one sense, 
and that a very fair one, literally true, no 
recovery taking place without sleep. In fact, 
this was inevitable. The patient was, in every 
instance of delirium tremens, excessively ex- 
hausted by loss of sleep, and by excessive and 
long-continued agitation. In such a case, a 
healthy person would feel an overpowering de- 
mand for sleep. How then could health return 
without it? It was a thing absolutely impos- 
sible. 

Yet, Dr. Coates had found this phrase to act 
powerfully on the minds of young practitioners, 
on whom the care of cases of this disease, fre- 
quently so mortal, was continually thrown in 
hospitals, and feared that it might tend to pro- 
mote an extravagant tone of judging cases. He 
believed that he could pledge himself in the 
most serious manner to the society that, dur- 
ing the long remainder of thirteen clinical ser- 
vices in the Pennsylvania Hospital, he, in 
every instance, absolutely, without exception, 
carefully refrained, either in this or in any 
other public way, from ever repeating it. He 
had, since 1824, positively never said so, either 
in lectures, or in public discussions. 

Yet, so fixed was the imputation against him 
of continually inculcating this, that a physician 
of much reputation in this city, and now prac- 
tising in New York, had actually sent him this 
phrase, as having been uttered by him on a 
day on which the gentleman alluded to had 
taken notes on one of his clinical lectures. Dr. 
Coates assured the society a third time that he 
had said no such thing. In fact, so violent had 
prejudice become, by constant repetition, that 



I more than half the notes were evidently writ- 
ten from imagination, and only the smaller 
amount were capable of being used. 

With regard to the allegation that he had 
never known or heard of any harm from opium, 
given in the way he had recommended, there 
was certainly some small allowance due for the 
difi'erence between 1824 and 1860! He had, 
since the former time, certainly both seen and 
heard of it. 

Some of his friends had given more than he 
had. His belief was that he had never given 
more than 42 grains of opium during the whole 
case. [60 grains and 72 grains were given by 
practitioners of high standing.] He had thought 
the practice forced on him in the hospital, by 
having desperate cases left entirely to his own 
care and discretion, while still a very young 
man, and had believed that the practice was 
not conducted in clear and distinct views, dif- 
ferent purposes in the treatment seeming to him 
to be vaguely mixed together, to the confusion 
of the treatment. 

Any gentleman who would, as he had pro- 
posed, do him the honor to refer to his memoir 
would find that he used and recommended a 
great variety of remedies : assafoetida, musk, 
ardent spirits, emetics, blisters to the head ; 
and that he earnestly pressed on the practi- 
tioner that no very large dose of opium should 
ever be repeated without a visit of inspection 
paid between, to judge of its effects. 

Success differed very much in different years. 
He had heard of a claim to have cured, with 
ardent spirits alone, something like 147 cases 
in 148. He had never had such success as this, 
unless for a short series of cases ; but he would 
not undertake to deny it. Sutton had claimed to 
have recovered the whole of 70 cases ; and Dr. 
Coates had defended Sutton's claim in the me- 
moir alluded to. Dr. Coates did not refrain froni 
stating that he had imputed moral censure in 
some instances. He was sensible that he had 
betrayed warmth when speaking of the above ; 
but this was common when men found their 
professional characters attacked. He could 
assure the company that none of his warmth 
was felt tov/ards any then present ; and he did 
not believe it was so against any of their par- 
ticular friends. 

He considered ardent spirits less suited to the 
case, because their sleep-producing power was 
combined with violent stimulation. This, he 
believed, he had found in general not necessary, 
and only used them for the common indications 
of need of more arterial and nervous excitement. 
Dr. Wood's recent work included a case that 
had got well under alcohol in 14 days. He 
would append to it a recent one of his own, of 
desperate and long-continued debauch, prac- 
tised with the avowed intention of producing 
suicide, which became perfectly and absolutely 
well, with the return of the natural appetites 
and healthy moral feelings, in four days, with 



November 3, 1860. 



MEDICAL SOCIETIES. 



115 



very little medication. This included 17 drops 
of good wine of Cannabis Indica. 

In acute rheumatism, he thought opium too 
universally recommended ; and had found, on 
very careful trials, a number of cases that im- 
proved faster, and had less pain under the use 
of simple nitrate of potassa, than under that of 
Dover's powder. 

He believed the gentleman who revised the 
Pharmacopoeia to have committed a mistake 
in returning to the use of sulphate of potassa, 
instead of nitrate, in making Dover's powder. 
The nitrate was a very important and useful 
part of the formula. 

He was impressed and pleased with the lec- 
turer's remark on the necessity of occasionally 
intermitting the use of opium where required 
to be long continued, in order to let the patient 
recover his natural susceptibility to the drug, 
and to prevent its use from becoming habitual, 
uncertain, and extravagant in the dose. He had 
particularly found this needed in pulmonary 
consumption, and most frequently advised the 
patient only to use opiate cough mixtures when 
the cough was worse than common, or when 
sleep was desirable, and not to suffer it to be- 
come habitual. 

Dr. Condie remarked, that notwithstanding 
the excellent account which had been given by 
Dr. Hamilton of the therapeutic properties of 
opium, so extensive was the ground covered by 
him, and so much had he entered into particu- 
lars, it was extremely difficult to follow him 
with any degree of closeness. The theme pre- 
sented for discussion was in itself one as copious 
as it was important. 

Of all the articles of the materia medica, the 
one we could the least easily dispense with was 
unquestionably opium. So many were the 
morbid conditions which called for its employ- 
ment, and where, from the use of no other 
remedy could be anticipated the same prompt, 
certain, and beneficial effects : so many and 
varied were the therapeutic indications it was 
adapted to fulfill, that few, if any, diseases could 
occur in one or other of whose stages opium 
did not constitute a prominent and important 
remedy. 

Most of the circumstances which contraindi- 
cate the employment of opium have been 
pointed out by Dr. H. in his opening remarks. He 
had not, however. Dr. Condie believed, included 
among those circumstances, the presence of 
congestion of the lungs. This, opium has al- 
ways the tendency to increase. 

A very strong temptation to the employment 
of opium in the leading affections of the lungs 
arises from the fact of its calming influence 
upon the frequent and harrassing cough by 
which most of these affections are attended. 
There is no doubt that, in nearly all of them, 
after the acute stage has passed, opium consti- 
tutes a valuable remedy. In moderate doses, 
combined with expectorants, it will be found, 
very generally, so far to relieve the violence 



and frequency of the cough in bronchitis and 
pneumonia as to permit the patient to obtain 
some hours sleep. But we must beware of giv- 
ing opium in large or repeated doses in the 
latter stage of acute bronchitis, or in cases of 
chronic bronchitis attended with a frequent se- 
vere cough, with but little expectoration. The free 
secretion which takes place in the course of an 
attack of bronchial inflammation from the 
mucous membrane of the bronchi, is always a 
beneficial result to be promoted rather than 
retarded or prevented, and, at the same time, 
we are to recollect that it is by coughing that 
the secreted matters are to be expelled from the 
lungs, where their retention and accumulation 
would be the cause of serious inconvenience. 
Now, opium has the effect of diminisbing or 
sometimes even arresting the secretion from the 
bronchial mucous membrane, and of suspend- 
ing to a greater or less extent, the cough. The 
disease of the bronchi, and with it the difficulty 
of respiration, and the pectoral oppression, will, 
in consequence, be increased, whenever opium 
is improperly and inopportunely administedin 
acute pulmonary diseases, partly from the in- 
creased congestion of the lining membrane of 
the bronchi, and partly from the accumulation 
of the fluids poured out from its surface within 
the air cells and respiratory passages. _ To sp 
great a degree, in some cases, does the impedi- 
ment to respiration arise from these causes, 
that the speedy death of the patient may even 
be the result. 

Dr. Condie referred to the case of a distin- 
guished clergyman of the Methodist Church, 
who had beenlaboring under chronic bronchitis 
for upwards of a year, when he came under his 
care. He had become greatly emaciated and 
feeble, and was deprived of sleep at night by an 
incessant painful cough, attended by a very 
copious expectoration. Not improving as ra- 
pidly as he had anticipated, he was induced by 
the flattering representations of an ignorant 
charlatan to take his medicine, which, he as- 
sured him, had been found in every instance 
where it had been used, in cases of consump- 
tion similar to his, to stop the cough promptly 
and effectually. The reverend gentleman com- 
menced the use of the article on Saturday; he 
slept tolerably well, and coughed but little dur- 
ing the night ; he concluded, therefore, that he 
was greatly benefited. On Sunday _ morning, 
contrary to the remonstrances of his family, 
who saw the increased oppression and difficulty 
of breathing under which he labored, he_ in- 
sisted upon attending church and preaching. 
After laboring with difficulty through the ser- 
vices of the desk, he was conveyed home from 
church, and went at once to bed. He died in 
the course of the night of apnoea, caused, as 
Dr. Condie was well convinced, by the action 
upon the bronchial secretion and the cough, of 
the opium which formed the active ingredient 
in the "pulmonic elixir," by which his cure 
was to have been effected. 



116 



MEDICAL SOCIETIES. 



Vol. V. No. 5. 



From the effect whicli opium has in dimin- 
ishing the discharges from the mucous mem- 
branes in health and disease, Dr. Condie re- 
marked, it may be advantageously resorted to 
in the profuse effusions into the bronchial 
canals we occasionally meet with. In such 
cases, when judiciously employed, in conjunc- 
tion with other remedies, it will always be 
found to give great relief, and to aid very effec- 
tually in effecting a cure. 

Dr. Hamilton, if Dr. Condie had correctly 
understood him, believed that opium was less 
injurious when administered in the ailments of 
children than it is generally supposed to be, 
and that it was adapted to a much greater ex- 
tent for the relief of their diseases than would 
be judged to be the case from the practice of 
the generality^ of contemporary physicians. 
This estimate is by no means, however, con- 
firmed by the result of Dr. Condie's experience. 
He had always found that opiates were very 
illy tolerated by young children even in those 
ailments in which their use had seemed to be 
the most positively indicated. He had known 
very minute doses— the sixteenth of a grain of 
Dover's powder, for instance — a combination of 
opium that is generally believed to agree the best 
with children — to produce in an infant, two years 
old, excessive narcotism, causing the little patient 
to remain in an almost comatose condition, in one 
instance, over forty-eight hours. But, Dr. Con- 
die observed, it is not always thus that are ex- 
hibited the bad effects of opium upon the or- 
ganism of the infant. When given in small 
doses daily for a long period, as is often done 
by ignorant or inconsiderate parents to relieve 
the colicky attacks with which children are so 
liable to be troubled, or to keep them quiet 
while the mother pursues her domestic occupa- 
tions, opium acts somewhat in the same man- 
ner as the habitual indulgence in intoxicating 
drinks does upon the adult, checking the pro- 
per nutrition of the infant's body, and render- 
ing It pale and emaciated, and, when awake, 
dull and peevish ; its countenance assumes a 
withered, discolored aspect, and a sour, suffer- 
ing look, like that of an ill-tempered superan- 
nuated man or woman. 

Dr. Hamilton believes that, when opium is 
administered by the rectum, its effects upon the 
system are not so promptly exhibited, and by no 
means to the same extent, as when given by the 
mouth ; and that, consequently, it may be em- 
ployed as an injection or suppository more 
boldly and in far larger doses than when it is 
introduced _ directly into the stomach. Dr. 
Condie believed this to be a very dangerous 
mistake. His experience had very fully sus- 
tained the statement of several of the continental 
therapeutists that the effects of opium, in the 
same doses,were equal, whether administered by 
the mouth or rectum. In some instances, a very 
moderate quantity of opium introduced per 
anum, he had known to produce intense narco- 
tism. When, however, opium has been given 



by enema, combined with some oleaginous sub- 
stance, as, for instance, with melted butter — a 
favorite prescription of the late Dr. Chapman 
in the dysentery and other painful bowel affec- 
tions of children — its effects are exhibited to a 
much less extent than when injected in com- 
bination with mucilage, or introduced in sub- 
stance. 

Dr. Hamilton had considered the employ- 
ment of opiates, in the case of children, to be 
strongly indicated, from the fact of the greater 
activity of the nervous system in them, and its 
predominating influence in the production, 
phenomena, and course of their diseases. Dr. 
Condie had supposed it to be universally 
conceded that, during infancy and childhood, 
it was chiefly the blood-making and nutritive 
systems that were most prominently active, 
and that the most frequent ailments at those 
periods of existence were those of digestion and 
nutrition. The ganglionic system of nerves, 
it is true, are then especially active and prone 
to derangements of various kinds. The ner- 
vous symptoms, by which the diseases of in- 
fancy and early childhood are often attended, 
are most generally secondary phenomena, the 
result of reflex action. Let this be as it may, 
opium, while it furnishes us with our very best 
remedy for allaying pain and quieting certain 
states of nervous excitement and irritation, had 
not been found, Dr. Condie believed-, a very po- 
tent agent for the prevention of, or allaying con- 
vulsive action. It has been recommended, it is 
true, in tetanus, chorea, epilepsy, the eclampsia 
of puerperal females, and in the convulsions of 
children, upon very high authority. The re- 
sults of its employment in the first four of these 
affections had not been, so far as Dr. Condie 
had ascertained, such as to recommend it very 
strongly to our confidence. In the general run 
of cases of convulsions in children, he would 
as soon think of administering opium to quell 
them as he would of resorting to active deple- 
tion by the lancet to cut short a case of typhoid 
fever. There are certainly many cases. Dr. 
Condie remarked, in which, after the convul- 
sive paroxysms had been subdued by appropri- 
ate measures, moderate doses of opium, admi- 
nistered by the mouth or as an injection, may 
prove highly beneficial. By quieting the un- 
due excitability which remains, it may even aid 
materially in preventing a return of the con- 
vulsive movements. 

Dr. Hamilton would appear to place a very 
low estimate upon oj)ium as a remedy in cases 
of epidemic, malignant, or spasmodic cholera. 
Dr. Condie, on the other hand, considered it 
to be one of the most essential and efficient of 
our means for the control of this formidable 
disease. His opportunities for the study of it, 
and for testing the influence upon the mortality 
attendant upon it under different plans of treat- 
ment, had been ample, he having served as 
chief physician to a large cholera hospital 
during its several epidemic visitations to our 



November 3, 18G0.] 



MEDICAL SOCIETIES. 



117 



city. The result of his experience had con- 
vinced him that it is utterly useless to depend 
for the cure of epidemic, or spasmodic cholera, 
upon any plan of treatment in which opium 
does not hold a prominent place. In a paper 
that appeared in one of the continental medical 
journals shortly after the epidemic of 1849, " On 
the Treatment of Cholera, ^^ it is very clearly 
proved, by a statistical exhibit of the results of 
various plans of treatment drawn from a num- 
ber of reliable sources, that the per centage of 
recoveries had always been decidedly in favor 
of those plans in which opium entered as a pro- 
minent remedy. The same thing Dr. Condie 
considered was shown very satisfactorily by the 
facts contained in the report on practical medi- 
cine and epidemics, read before the Ameri- 
can Medical Association by Dr. J. K.Mitchell, 
at the session of 1850. It may, perhaps, be ob- 
jected, as he had known it to be to a series of sta- 
tistics presented to another body by a gentleman 
holding, at the time, a professorship in one of 
our medical schools, that in the statistics in 
question were included a large number of cases 
that were not strictly those of spasmodic cho- 
lera—they being unwilling to consider any at- 
tack as one of that disease which was not cha- 
racterized by a cold, livid tongue and surface, 
shriveled extremities, or slow, thready, or 
scarcely-perceptible pulse, extinct voice, etc. 
If these persons are correct, then Dr. Condie 
was willing to admit that little, if any, depend- 
ence was to be placed in the efficacy of opium 
in the treatment of cholera. But, if it be cor- 
rect to say that to those physicians who had 
almost invariably succeeded in preventing the 
occurrence of this condition of collapse, by ar- 
resting the disease in its first or second stages, 
is to be ascribed the largest amount of success 
in the cure of cholera, then is the truth of the 
position to be also admitted that oj^ium is the 
most efficient remedy for the disease, inasmuch 
as it will be found, upon a candid investigation of 
all the facts upon record, that it was mainly 
to an early and judicious resort to opium, in 
conjunction with astringents, their success is to 
be attributed. 

Dr. Condie was of opinion that, in the open- 
ing remarks of Dr. H., he might have urged 
even more strongly than he did, the im- 
portant remedial influence exercised by opium 
in all inflammatory affections, after the first 
acute stage had been overcome. This influence 
is not evinced simply in the inflammatory affec- 
tions of the mucous membrane, bttt to an equal 
degree in those also of the serous membranes 
generally. 

Dr._ Hamilton referred to the curative power 
exercised by opium in puerperal peritonitis. 
If by the latter name he had intended to in- 
dicate true puerperal fever. Dr. Condie stated 
that he would be obliged to ascertain the 
extent to differ in opinion from him. In his esti- 
mation, true puerperal fever was something 
more than merely a severe febrile excitement, 



the result of inflammation of the peritoneum, 
or of the womb and its appendages, while in 
its treatment he did not esteem opium a promi- 
nent remedy. In simple acute peritonitis, whe- 
ther occurring during or out of the puerperal 
state, opium he admitted to be an all-important 
remedy, after direct depletion had been carried 
to a proper extent. 

It had been his desire. Dr. Condie observed, 
to inquire into the remedial value of opium in 
certain morbid states of the human organism 
to which Dr. Hamilton had not at all, or only 
cursorily, alluded, but having already occupied 
the attention of the society for, perhaps, too 
long a period, he would here close vdth the ge- 
neral remark that the nature of opium, as a 
therapeutic agent, does not consist simply in its 
property of allaying pain, of calming nervous 
irritation, and of procuring sleep. Important 
as is the aid it furnishes in the successful ma- 
nagement of disease, by virtue of these proper- 
ties, it possesses, in addition to them, others of 
a directly curative character, and which alone 
would command for it a very high rank upon 
the list of the materia medica. 

Dr. Hamilton said he had, perhaps, not read 
the paper presented distinctly, or loud enough 
to be at all times understood. In reply to 
what had been said by the gentleman who last 
occupied the floor, of the danger attending the 
use of opium in the diseases of children, he 
would observe that reiterated cautions were given 
in regard — to the necessity of attending to the 
contraindications in the use of opium in gene- 
ral, and especially in the cases of children — to a 
strict observance of its effects, and where the 
indications are not clear, to the propriety of its 
suspension or non-employment. Further than 
this he did not see the necessity of going. In 
reference to the benefit to be derived from the 
action of injections containing laudanum, in 
the convulsions occurring so often in children, 
as the consequence of intestinal or dental irri- 
tation, and to which exception has been made, 
his own experience was quite satisfactory. 
Abotit ten years ago, the late Dr. Oavin Wat- 
son transferred to the care of Dr. H., a child, 
not quite a year old, affected with convulsions, 
apparently caused by dentition. Eight attacks 
had occurred, when Dr. W. was unable longer 
to attend. Ten or twelve other attacks ensued 
whilst the case was in charge of Dr. H. The 
usual remedial measures having proven in- 
effectual, and the mother of the child remark- 
ing that the attacks did not vary more than 
five minutes in intervals of about half an hour, 
it was determined to try the effect of an injec- 
tion of starch, containing ten drops of lauda- 
num. This course was predicated upon the pro- 
bable purely nervous origin of the convulsive 
movements, as shown in the regular periods of 
return. No convulsion took place after ^ this injec- 
tion. From that time to the present, it was the 
custom of Dr. H., after giving proper attention 
I to the condition of the gums, the stomach, and 



118 



MEDICAL SOCIETIES. 



Vol. V. No. 5. 



bowels, and the vascular system, to depend 
much, in these cases upon the sedative and an- 
tispasmodic power of opium. Such attacks, in 
children not yet weaned, are probably due, in 
most cases, to dental irritation, and this view 
seems strengthened, upon calling to mind that 
a similar condition occurs in the animal crea- 
tion, as is seen in the convulsive attacks of 
dogs and kittens, occurring during the progress 
of dentition. The indication, in these cases, is 
to subdue irritation, and when this is accom- 
plished, the sudden starting of the child, and 
the twitching of tendons (premonitory of other 
probable attacks) so often seen in children, dis- 
appear, and the danger of recurring attacks is 
of course further removed. 

The President, Dr. Eemington, (having called 
Dr. Nebinger to the chair,) said: That one 
great objection to the employment of opium in 
treating the diseases of children, was the im- 
pairment of the tone of the digestive organs, 
and its decided tendencies to the brain. The 
mischievous results of this practice are often 
observed where opiates, in the shape of some 
popular nostrum, or anodyne drops, are habit- 
ually resorted to, to keep the child from crying 
during the mother's absence. 

He related a case of cholera infantum occur- 
ring in the winter season, induced by the long- 
continued, habitual use of laudanum, given to 
relieve colic, and to procure sleep while the 
mother was absent from home, occupied with 
other duties. The opiate was interdicted, and, 
under good diet and appropriate treatment, the 
child rapidly recovered. 

The indiscriminate use of this article in dis- 
eases of children is highly pernicious, and even 
hazardous to life, by causing convulsions, consti- 
pated bowels and determinations to the brain. 
Although it is argued that as their brain and 
nervous system aremorelargely developed than 
in adults, they necessarily suffer more intensely 
from pain, and hence the greater necessity for 
opiates. In cases of extreme anguish and suf- 
fering from strangury and irritable bladder, as 
produced by blisters, he regards an enema, 
composed of one teaspoonful of laudanum in a 
little flaxseed mucilage, as a highly efficient 
and almost infallible remedy. In purely ner- 
vous pain and irritability, unattended with 
fever or inflammation, it is indispensable. He 
has employed it extensively, conjoined with al- 
coholic stimuli, in the treatment of mania-a-potu, 
and in some cases pushed it to the extent of 5 
or 6 grs. every hour for 6 or 8 hours, but not 
always with a happy result in these large doses. 
To relieve the tormina and tenesmus attendant 
on dysentery, it is particularly useful. 

Dr. DiVRRACH remarked, that, with other 
merits, the paper of Dr. Hamilton was very 
suggestive. 

One of its suggestions was the combinations 
of opium. Efficient as is the separate agency 
of this important medicine, the utility of it is 
greatly increased by its combination with cin- 



chona and its salts ; the salts and oxide of an- 
timony ; the oxides and salts of mercury ; and 
with camphor, ipecacuanha, and other first class 
agents. 

In regard to the first of them, he remarked, 
that although Sydenham and Morton had re- 
stored the use of Loxa bark by better timing its 
administration, yet Talbot, by combining it 
with opium so augmented its power, that he, 
an emperick, became the preferred practitioner 
throughout England and France. The combi- 
nation, said Dr. D., is supported by the sensor- 
motor doctrine of Bell and Hale, and has been 
confirmed by his own practice. 

He has also very advantageously combined 
the antiperiodic and sedative in the early morn- 
ing apyrexia of epidemics. During it, the 
thirtieth of a grain of sulphate of morphia, 
with two grains of sulphate of quinia, admin- 
istered hourly, will not only most happily co- 
operate with the then tendency to sleep, but 
also, by augmenting the efficiency of the qui- 
nia, weakens and shortens subsequent exacer- 
bations, prevents degeneration of blood, and se- 
cures a favorable crisis. 

In respect to antimony, the most admirable 
and valuable combination is its oxide and sul- 
phate of morphia, with phosphate of lime. 
Opium, as we know, aggravates the severe eve- 
ning exacerbation, but the above relaxes, there- 
by allows sleep, and consequently sustains 
strength, and prepares the system for the tonic 
in the coming apyrexia. He regards this, there- 
fore, an improvement in the therapeutics of epi- 
demics. 

Opium with camphor is essentially the parego- 
ric elixir of the nursery and the efficient remedy 
in afterpains. In cholera, each is beneficial, but 
more so m combination; and if calomel be 
added, a triple agent of greatly increased power 
is made. 

Calomel and opium, after the use of blood- 
letting and antimony, is the reliable practice in 
the abdominal phlegmasiee — membranous and 
parenchymal — enteritis especially could not be 
subdued without it. 

Opium with ipecacuanha is another most effi- 
cient combination. The latter, by its revulsive 
action on the stomach, duodenum, and liver, 
abates the dysenteric action on the colon, and 
by its centrifugal tendency, revives the endermic 
functions, and thus becomes the specific in dys- 
entery. But, subsequently, by union with opium, 
tormina and tenusmus are quickly relieved ; 
and more recently by the addition of calomel, 
which removes the congestion of the portal sys- 
tem and re-establishes the formation of bile, a 
pill is formed of cal. ipecac, and opium which, 
with moist application of a mild sinapism to 
the abdomen and diet of farinaceous fluids, con- 
stitutes the treatment of this distressing and 
too fatal disease. To these cardinal combina- 
tions of opium may be added the Dover's pow- 
der, and others, which need no comment. 
Other suggestions of the paper relate to the 



November 3, 1860. 



MEDICAL SOCIETIES. 



119 



administration of opium to the stomach, rec- 
tum, skin, and binding tissue. He had been 
advantageously taught at the Hotel de Dieu, by 
Dupuytren, that the rectum was to be preferred 
to the stomach, and that it was not necessary 
to augment the dose. Dr. D. regarded the most 
direct action of opium to be upon the ganglion 
system, of which he regarded the prima via3, the 
esodic surface ; and that the soporific influence 
is on perception by reflex action on the senso- 
rium ; but that when opium is directly applied 
to the skin or cellular tissue beneath, the action 
is direct on the sensorium. 

With these views, he has consequently avoid- 
ed the use of opium by the stomach as much 
as possible. 

Dr. Thomas said that he regretted that the 
lateness of the hour would prevent a fuller dis- 
cussion of this important matter. Among 
other points, he would like to learn the views 
of the members with reference to the relative 
quantities of opium required to produce the 
same effect, when administered by the skin, by 
the mouth, and by the rectum. Also, the com- 
parative value of opium and the salts of mor- 
phia. And also, the propriety of administering 
or withholding either in diseases of the brain. 
These important subjects merit more than 
a passing consideration. It is true the gentle- 
man who made the opening address has adopt- 
ed the views of Trousseau, who declares the salts 
of morphia to be more prompt in their action 
upon the nervous system, and more decided in 
effect when introduced by the skin than if given 
by the mouth, the dose being the same. As 
this conclusion is contrary to the evidence of 
numerous observers, and opposed to the teach- 
ing of the bedside. Dr. T. could not adopt it. 
Nor was he prepared to coincide with the prac- 
tice of Dr. C, who spoke of his habit of admin- 
istering a tea-spoonful of laudanum as an injec- 
tion, when he was desirous of producing an ano- 
dyne influence, and circumstances forbade its 
exhibition by the mouth. With every allow- 
ance for the difference in the strength of com- 
mercial opium, and as a consequence of its pre- 
parations, this dose being five to six times 
greater than what is ordinarily considered as 
the proper quantity of laudanum by the mouth, 
must be regarded as excessive. He has re- 
peatedly witnessed a more decided soporific ef- 
fect from an injection of forty-five drops of lau- 
danum, than from twenty-five drops, or one 
grain of solid opium taken internally. He had 
cognizance of a case of fatal stupor occurring 
immediately after an enema of a table-spoonful 
of the tincture ; but whether death was coinci- 
dent from the disease, whose chief manifesta- 
tion was in the form of wakefulness and nervous 
excitement, or whether from the remedy, must 
ever remain undetermined. 

With reference to the relative merits of opium 
and the salts of morphia, he merely asked at- 
tention to the fact that the manufacturing 
chemists are satisfied with a yield of eight per 



cent, of morphia from the opium subjected to 
examination. Hence if this alkaloid be the sole 
active agent in the drug, one grain of it should 
equal, in efficiency, twelve and a half grains of 
crude opium. But as we all know that one 
grain of morphia, or of any of its salts, is not 
stronger than five or six grains of opium, the 
inference is obvious, that other principles en- 
dowed with activity must be present, and, con- 
sequently, the alkaloid mentioned cannot rep- 
resent the entire virtues of the drug. 

As regards the employment of opiates in dis- 
eases of the brain, whether idiopathic or the 
result of injury, Dr. T. was inclined to question 
the propriety of withholding them, under a fear 
of increasing excitement from their supposed 
stimulant effect. Names sometimes mislead 
us. The stimulation of opium in full doses is 
but transient, and is followed by direct, positive, 
and enduring sedation, which latter effect is 
often specially indicated in the treatment of 
the diseases in question. Hospital cases oc- 
casionally furnish striking confirmations of this 
fact, and allusion was made particularly to three 
cases of injury to the brain, recently under his 
care, in each of which blood was discharged 
from one or both ears, and in two the tympa- 
nic membranes were burst, with other evidences 
of alarming lesions from external violence. 
After the primary reaction had subsided in all of 
these patients, one-fourth of a grain of morphia, 
combined with three grains of extract of conium, 
was given every three hours for several days, 
with the most satisfactory result. No approach 
to coma was manifested, the pulse continued 
slow and regular, the mind and body both re- 
mained quiescent, and no appearance of deli- 
rium occurred. In due time, all recovered, the 
result being due, in great measure, as he believed, 
to the perfect rest enjoined upon the brain. 

In idiopathic disease of this organ, he does 
not hesitate to use the same remedies, premising 
depletion, and combining them with the mercu- 
rials. 

Dr. Morris remarked that he had hoped to- 
night to hear in the discussion of the therapeutic 
influences of opium, the views of the members 
with regard to the modus operandi of the drug, 
rather than the statement of the different dis- 
eases in which it might be useful. This subject, 
it seemed to him, might be discussed with great 
practical advantage, as tending to settle the 
much-disputed point of the stimulant or seda- 
tive qualities possessed by it. He advanced the 
hypothesis that opium acts directly only upon 
nerve-centres of sensation, producing in them 
a more or less complete paralysis. If we apply 
a solution of opium to a sentient surface, we 
produce in it a more or less complete local anaes- 
thesia. If we administer it in moderately large 
doses this anaesthesia becomes general.^ No 
increase or diminution of motor power is ob- 
served. At first the pulse is quickened, but 
soon it becomes full and slow. As the narcotic 
influence increases, the respiration becomes evi- 



120 



PEEISCOPE— REVIEWS AND BOOK NOTICES. 



Vol. V. No. 5. 



dently impeded ; the movements of the chest 
become less frequent ; the aeration of the blood 
takes place imperfectly ; the numbing influ- 
ence has extended to the respiratory centres of 
the medulla oblongata, so that the besoin de res- 
pirer is no longer perceived. If this effect goes 
on to increase, the respiration becomes slower 
and slower ; carbonized blood accumulates in 
the venous and capillary systems, engorging the 
brain, the lungs, liver, and heart ; finally, death 
ensues by asphyxia. Can we fairly place this 
engorgement to the primary action of the drug ? 
or is it not rather due to the depraved condition 
of the blood, brought about by the insensibility 
of the nervous-centres ? 

Then, again, as to the uses of opium in dis- 
ease. Pain is one of the greatest exhausters 
of nerve-force, if not the greatest, known to us. 
Now, by obtunding the sensibility of the nerve- 
centres, we may, in' many cases, prevent the un- 
due expenditure of the powers of our patients, 
thus allowing these husbanded pov>^ers to be use- 
fully applied by nature in the restoration of 
diseased parts. On this principle, and this alone, 
is to be explained the so-called alterative in- 
fluence of opium in cases of chronic inflamma- 
tion. Mr. Skey has called the attention of the 
profession to the advantage to be derived from 
the nightly administration of opium in cases of 
chronic ulcer of the leg. If we suppose that an 
irritation is produced by the sore, in the poste- 
rior gray matter of the spinal cord, from which 
an influence is sent by the anterior root dilating 
the blood-vessels of the part, as seems to be 
proved by recent researches, we can easily com- 
prehend that an agent capable of allaying the 
irritability of the nerve-centre, will allow of the 
restoration of the natural calibre of the blood- 
vessels, and the consequent amelioration of the 
patient. 

Adjourned. 



EDITORIAL DEPARTMENT. 

PERISCOPE. 

MILK SECRETED BY TUMORS IN THE AXILLA. 

Dr. J. Harris reports, in the Savannah Jour, of 
Med., the case of a healthy negro woman, aged 
28 years, who, shortly after the birth of her 
third and fourth children, experienced large 
swellings in the axilla, which continued without 
interference during lactation. 

The same swellings occurred after the birth 
of her sixth child on the appearance of the milk 
in the mammary glands, and with a similar 
sensation. During the period of this lactation 
the tumors were tapped, and a pint of fluid, 
having all the physical and chemical character- 
istics of milk, was evacuated. The fluid, when 
first examined, had an acid reaction. Under 
the microscope the/ai globules of milk were appa- 



rent, and scattered through the field of view 
appeared the very characteristic colostrum corpus- 
cles, conglomerates of fine fatty molecules, aggre- 
gated by means of a hyaline substance scarcely 
perceptible. No pus corpuscles were found, and, 
by chemical examination, the absence of pus 
was confirmed. Chemical examination proved 
the existence of all the constituents of colostrum 
and milk. 



REVIEWS AND BOOK NOTICES. 

Observations upon the Form of the Occiput in 
THE ^various Eaces OF Men. — By J. Aitken 
Meigs, M. D., Professor of the Institutes of Medi- 
cine in the Medical Department of Pennsylvania 
College, etc. etc. 

Prof. Meigs has devoted much study to Cra- 
niology, and as the results of his labors we have 
an elaborate and highly interesting paper, of the 
above title, read before the Academy of Natural 
Sciences of Philadelphia, and published in its 
proceedings. The conclusions arrived at by 
Prof. Meigs, we give in extenso, because, un- 
doubtedly, they will prove interesting to many 
of our readers. 

" 1. That the form of the human occiput is 
not constant. On the contrary, it varies con- 
tinually in the different races and tribes of men. 
It varies, also, to a greater or less extent among 
the individuals of the same race or tribe. 

" 2. That the different occipital forms may be 
divided into five classes or groups, which are 
reducible, however, to three. These are, 1st. 
The protuberant or prominent occiput, with the 
upper or parietal half somewhat flattened, so as 
to present an inclined or shelving appearance. 
2d. The vertically flattened. 3d. The inferiorily 
flattened or compressed, in which the basal por- 
tion of the occiput slants upwards and back- 
wards, as is shown in a strongly marked degree, 
in the Sandwich Islander head, fig. 69, on page 
340 of " Indigenous Eaces of the Earth." ■ 4th. 
The round. And 5th. The globular. As the 
last two merge more or less into each other, 
and as the third form may be regarded as, in 
many instances, a modification of the second, 
these five forms may, with greater simplicity, 
be thrown into three groups, viz : — 1st. The 
prominent and oval, or superiorly inclined. 2d. 
The perpendicularly flattened. And 3d. The 
more or less round or globular. 

"3. That to the first of these groups belong 
the Norwegians, Swedes, and some other Scan- 
dinavians ; the Frisians and Batavians,* among 
the low Germans ; the Anglo-Saxons and Anglo- 
Americans, the form of the occiput in these 
being between that of the Swedes and Grermans ; 

* See Catalogus Craniorum diversarum Gentium quae collegit> 
J. "Van der Hoeven, p. 14. 



November 3, 1860. 



EEVIEWS AND BOOK NOTICES. 



121 



the Celtic Irisli, and some of tlie tribes of the 
ancient Britons; the Phoenicians, Circassians, 
Armenians, Atfghans, Baluchi ; some of the 
Egyptians and Arabs, the Fellahs, Abyssinians, 
and Guanches of the Canary Isles ; some of the 
Hindoos and Chinese ; the Loo-Chooans, cer- 
tain Malays ; the Eskimos, Kamskatkans, Eein- 
deer Tungus, Icelanders, Tchuktchi, Unalasch- 
kans, some of the Kanakas, Tahitians, and 
others of the Sandwich Islands, Marquesans, 
of Nukahivah, New Zealanders, Feejeans, and 
most of the African tribes. Among the aborigi- 
nal Americans, this form is exhibited by the 
Arickarees, Assinaboins, Cherokees, Chippe- 
ways ; some of the Kootenays, Creeks and Da- 
cotas ; by the Hurons, and probably the Illi- 
nois ; by some of the Iroquois and most of the 
Lenapes; by the Mandans, Minetaris, Menomi- 
nees, Miamis, Mohawks, and most of the Nar- 
ragansetts, the Naticks, some of the Osages, 
Ottawatomies, Pawnees, and Sanks ; by most 
of the Seminoles, by the Shawnees, Shoshone, 
Upsarookas, Californians, Cayngas, Cheyennes, 
Choctaws, Massasaugas, Mingos, Naumkeags, 
Mayas of Central America ; by some of the 
Araucanians, the Charibs, Patagonians, Bra- 
zillians, Aymaras, and by some of the Ancient 
Mound Builders, Peruvians, and Mexicans. 

" In the kumbekephalic variety of skulls, this 
form of occiput is often very much exaggerated, 
as is seen in certain ancient Cimbrian, Ostro- 
goth, and Burgundian heads : in some Egyp- 
tians and Celtic Irish, and in one Creek Indian 
skull. 

"4. That of the second form of occiput, orthat 
in which the hind-head is more or less vertically 
flattened, we find examples in some of the an- 
cient inhabitants of Scandinavia; the Lapps, 
Samoiedes, Iberians, or Basques of the Pyre- 
nees ; the Ancient Pelasgi ; Cossacks, Hunga- 
rians, Candaharians, some Arabs ; one Chinese, 
the Siamese, some Malays and Javanese ; cer- 
tain tribes of the Transgangetic, or Indo-Chi- 
nese Peninsula, and occasionally among the 
Tahitians. To this group belong, also, the 
skulls of Chetimache, Natchez, Otoe, Keneha- 
wha, Oneida, Seneca, and Puelche Indians ; 
likewise a portion of the Kootenays, Lenapes, 
Miamis, Osages, Ottawas, Pottawatomies, Sho- 
shones, Araucanians, Peruvians, and the ma- 
jority of the Mound Builders. 

"Examples of the inferiorly flattened modifi- 
cation of, or deviation from this type, are found 
in some of the Malays, Polynesians, &c. 

"5. That the third form, in which the occi- 
put is full and rounded, or globular, comprises 
the Danes, Finns, Esthonians; the short-headed 
Germans, whose crania, in general conforma- 
tion, occupy a place between those of the Swedes 
and Fins ; the Dutch, some tribes of the an- 
cient Britons ; the Sclaves, Turks, Grreeks, Eo- 
mons, Etruscans, Persians, ancient Assyrians, 
some of the Egyptians, Hebrews, Copts, Hin- 
doos ; some of the Chinese, Japanese, Burmese, 
Malays ; the Kalmucks, Burats, and some of 



the Kanakas. To this group belong, of the 
American Indians, the Ottigamies, Penobscots, 
Winnebagos, Ymasees, Chemasyans, Euchees, 
Nanticokes, Pocassets, Quinnipiacks, or Mohe- 
gans, and a portion of the Cheyennes, Creeks, 
Dacotas, Iroquois, Narragansets, Pawnees, Pot- 
tawotimies, Sauks, Seminoles, Araucanians, 
Peruvians, and Mound Builders. 

"6. That the shelving or oval form of the 
occiput is most common in the doiichokephalic 
heads, and as these predominate in number 
over the brachykephalic, it is the most common 
form of all. Next comes the round or globular, 
and lastly the vertically flat — both these forms 
prevailing in the brachykephal^. 

" 7. That there is a marked tendency of these 
forms to graduate into each other, more or less 
insensibly. None of these forms can be said 
to belong exclusively to any race or tribe. None 
of them, therefore, can be regarded as strictly 
typical, for, a character or form, to be truly 
typical, should be exclusive and constant.^^ 



The Pocket Anatomist : Being a Complete De- 
scription OF THE Anatomy of the Human 
Body, for the use of Students. By M, W. 
HiLLES, formerly Lecturer on Anatomy and Phy- 
siology at the Westminster Hospital School of 
Medicine, etc. Philadelphia: Lindsay & Bla- 

KISTON, 1860. 

Little books have always been popular with 
students. The idea of saving time by grasping 
in a brief space a subject, without laboring 
through a detail of the matter, seems to be a 
delightful illusion to the tyro. The science of 
anatomy presented in a brochure, which may be 
carried in the breeches pocket, seems much less 
formidable to him than when spread out through 
ponderous volumes. Still, we believe, that the 
demand for such compends by students is suffi- 
cient evidence of their practical usefulness, and 
that if kept to their proper uses, for ready refe- 
rence and as remembrances always at hand, 
their utility cannot be questioned. 

Anatomy being that department which most 
taxes the memory of the student, such a remem- 
brancer as the present may be a valuable aid to 
beginners. 

The compiler of it is well known as a writer 
and an anatomist, and his work on regional 
anatomy, also, an abridgement, is really a very 
excellent work. 

The work is exceedingly condensed, yet as 
explicit as could be accomplished in the limited 
space. 

Experience fully warrants the inference that 
mercury is a general stimulant to all those func- 
tions of organic life which are j^erformed under 
the innervation of the ganglia of the sympa- 
thetic system. It is probable that its action is 
upon these ganglia. Thus, mercury tends to 
diffuse and equalize secretion, and the circula- 
tion of the blood, aiding, in this way, to break 
up local congestions and inflammations. — Harts- 
home's Medical Principles. 



222 EDITORIAL 

TflE MEDICAL AND SURGICAL REPORTER. 



Vol. V. No. 5. 



PHILADELPHIA, SATURDAY, NOYEMBER 3, 1860. 

WHAT IS OUE DUTY? 

It is but a few days ago that a physician in 
active practice, in a city between Philadelphia 
and New York, told us that he was called a 
short time since to see a woman in labor, and 
bring along his forceps, as the midwife in at- 
tendance had pronounced the head " locked.'' 
He went, and upon his arrival at the patient's 
house found a "Doctor" — one who goes by that 
name, but in reality an ignorant barber — and a 
midwife, in attendance, who both assured him 
that the patient had been in labor for three 
days, with the head "locked." On examination, 
it was found that the woman was not pregnant 
at all, and that the " locked head" of the foetus 
was simply a somewhat hardened os uteri. It 
was only because the barber-quack in this in- 
stance had no suitable forceps that he did not 
" deliver J' What injury he might have done, 
had he been in possession of forceps, whether 
the woman would have had her uterus literally 
torn out of her body, or might have escaped 
with half a dozen recto- and vesico-vaginal fis- 
tulas, is impossible to tell. 

In another instance, ' ' a j)laster-quack," who af- 
terwards was honored by the diploma of a regu- 
lar medical college, treated a case of dislocated 
jaws, and another of dislocated shoulder, by 
putting his universal healing salve over the res- 
pective parts, saying that it would draw the 
bones in their places. 

We have chosen two of the most striking ex- 
amples of this kind, which could easily be mul- 
tiplied by hundreds, and which happen all over 
the country, as a text for some remarks upon 
the duties of the medical profession in prevent- 
ing the people from becoming the victims of the 
miserable pretenders who infest our cities and 
towns from one end of the Union to the other. 

In speaking, however, of the duty of the pro- 
fession in view of the dangers which arise to the 
public health from the unlimited sway which 
these pretenders have, and in view of the laxity 
with which the laws are executed, where laws 



exist, preventing the ignorant quack from med- 
ling with the life and health of the community, 
at the outset we are often met with the objec- 
tion, that the profession is liable to the charge 
of engaging in a personal warfare with these 
pretenders. Indeed, not only among ignorant 
fools without, but within our ranks, among 
those who are timid beyond all forbearance, we 
hear the cry o^ persecution, persecution ! as soon 
as an effort is made to bring the criminal reck- 
lessness or mean cupidity of quacks either be- 
fore the bars of justice or the forum of public 
opinion. 

A noteworthy example of this kind, and one 
which it is our duty as journalists to mention, 
because it illustrates the sentiment pervading, 
to a slight extent we hope, the profession, hap- 
pened within a short time in a county medical 
society of a neighboring State. The facts of the 
case are simple. There are members of that 
society who are engaged in the drug-business 
and the sale of quack medicines and nostrums. 
Efforts had been made for years to rid the so- 
ciety of members who thus openly violated the 
code under which they were members, under 
which they sent delegates to the State Medical 
Society and to the American Medical Associa- 
tion. The matter, after being dragged through 
several meetings, came up for a final decision, 
and resolutions, declaring that hereafter no 
one engaged in the trafific of quack medicines 
should be admitted, were voted down. 

It is not our purpose to go behind the vote 
and the facts in the case. This society cannot 
hereafter consistently send delegates to the 
American Medical Association, or its delegates 
be received by that body, whose code they have 
deliberately annulled by a formal vote. And 
yet we do not accuse the society nor any of its 
members of being advocates of the traffic, 
with the exception of those who are directly 
concerned in it. We refer to the mfatter to 
show how, with the best motives, men may be 
misguided by too much timidity, and do injus- 
tice to themselves. 

The public will never come to look upon 
quackery intelligently, unless the profession cut 
off all alliance with it in every shape, way, or 



NOTEMBER 3, 1860. 



EDITORIAL. 



123 



manner. To this end it is necessary that the 
American Medical Association should keep a 
strict watch upon its constituents, and as soon as 
that body shall have created its own standard of 
medical education and respectability, necessary 
for admission as a member, and its member- 
ship be expressed in some formal title, the con- 
fusion of " Doctors," at present so disastrous to 
the true interests of the profession, will cease 
to reign. The profession is waking up to the 
necessity of this step first advocated in the 
Reporter, and adopted by the oldest medical 
society in the United States, and we are con- 
vinced the day will not be far off when the 
title of "Doctor" will be supplanted by one 
more honorable and less questionable than the 
former in the present confusion, and origina- 
ting from a better source than it often does now ; 
and,, to contribute to this end, we consider the 
duty of every member of the profession who 
takes interest in its welfare. 



THE PHILADELPHIA HOSPITAL. 

We observe that the clinics at this hospital 
are well attended. There is ample material 
here for a very thorough course of clinical in- 
struction, and we doubt not that the able phy- 
sicians, and surgeons, on whom devolve the duty 
of lecturing to the class, will give a course that 
will be creditable to themselves, and the insti- 
tution, and profitable to the large class in at- 
tendance. 

Dr. Agnew has been appointed curator of the 
Pathological Museum lately established in con- 
nection with the hospital. He will have oppor- 
tunities, which he will gladly avail himself of, 
to do much to advance the interests of patholo- 
gical science. 

There is, also, a very valuable library con- 
nected with this hospital, containing several 
thousand volumes, many of which have been 
carefully studied by some of the brightest lights 
that now adorn our profession in this country. 
During the dark ages, from whicli this institu- 
tion has lately happily emerged, this library 
w;as almost totally neglected. With the excep 
tion of one or two years, the annual appropria- 
tion made to replenish the library and keep it 
10 



in order, has, for many years been diverted into 
other channels, and it has consequently fallen 
behind-hand in regard to a supply of modern 
works on medical science. We are glad, how- 
ever, to learn that the present librarian is en- 
deavoring to make up these deficiencies, and 
hope that this valuable library will re-assume 
the rank which it once held. We commend it 
to the notice of our readers, and hope that they 
will, as opportunity offers, contribute to its col- 
lection surplus volumes from their own shelves. 



MORTALITY STATISTICS. 

In St. Louis, for the week ending Oct. 20th, 
twenty deaths are recorded as having occurred 
from diphtheria, out of the whole number of 
113. This gives a little over 17 per cent., and 
coincides with reports which have reached us 
otherwise, of the fearful severity with which 
the disease is spreading in some parts of the 
Western States, especially Illinois and Mis- 
souri. In New York and Philadelphia, the 
mortality reports show a decrease in this dis- 
ease, and an increase of scarlatina for the last 
few weeks. 

Among the deaths in Charleston is included 
one which, in the report sent us, is termed a 
" visitation of God." We have been unable to 
discover this in any of our nosological systems, 
and were hence obliged to throw it among, the 
unknown causes. 



SPIRIT OF THE MEDICAL PRESS. 

The leader in the London Lancet of October 
13th is devoted to a consideration of the adul- 
teration act and its results, from which it ap- 
pears that the act has achieved something ia 
the way of rendering adulterations in food and 
drink less frequent than formerly, though the 
government officials appear to look upon it 
rather in the light of a measure of revenue, 
than as a sanitary measure. Hopes are enter- 
tained, however, that the medical officers of 
health will gradually extend its influence so as 
to render it still more efi'ective for the protec- 
tion of the public. 

The same journal comments upon the medi- 
I cal management of the Insane Djepartment of 



124 



COEEESPONDENCE. 



Vol. V. No. 5. 



-the Melbourne General Hospital. It seems 
that a committee was appointed to investigate 
the management of the institution. We are 
informed, says the Lancet, Dr. McCrea insisted 
that in former years the patients died from 
" plethora/^ or, at any rate, that they had more 
food than was good for them. Dr. Bowie, on 
the other hand, maintained that the inmates 
are now suffering from the effects of starvation. 
It seems that Drs. McCrea and Bowie have 
been engaged in discussing their difference of 
opinion in the public prints, and illustrated 
what a Melbourne paper calls their "well- 
known incompatibility of temper." A com- 
promise was, however, finally made, and there 
is no longer danger of the patients being fed up 
to apoplexy or down to starvation. 



EUROPEAN CORRESPONDENCE. 
Gas-Leakage in London— St. Bartholomew's Hospital— The Ope- 
rating Room — Uncomfortable Arrangements. 

London, Friday, Oct. 12, 1860. 
Editors of Medical and Surgical Reporter :' 

GrEXTLEMEN : — In looking over your journal a 
few weeks ago, I noticed an observation on the 
London gas, which referred to its bad odor. To 
this I can bear witness ; indeed, at the present 
moment, the room where I am writing is ren- 
dered extremely disagreeable by it. I notice it 
even now, after having been in it for some time; 
but, in entering from the fresh air, it seems al- 
most insupportable. 

I have improved my brief sojourn in London, 
this time, by a visit to St. Bartholomew's Hos- 
pital, that oldest and richest, as well as largest, 
of all the London hospitals. It is situated near 
St. Paul's Cathedral, in the very centre of the 
city, and it is by the improvement and immense 
rise in value of the ground, belonging to it, that 
it enjoys its present wealth. 

There are three entrances to the hospital, be- 
tween which are houses not belonging to it, for 
the buildings composing it are mostly at a little 
distance from the street, and I suppose they 
consider the value of land as too great, to war- 
rant them in wasting any space. I had a little 
difficulty at first in getting admission, as I went 
unprovided with any letter of introduction. At 
the first gate the porter absolutely refused me 
admission ; but at last, on my showing him my 
card and asking him to let me see some of the 
surgeons or physicians, he referred me to an- 



other one of the three entrances. At this en- 
trance I was sent back to the first ; but on my 
way back, seeing a large carriage way leading 
into the centre of the buildings, I attempted 
entrance by it, and found nobody to stand in my 
way. One of the officials, standing near, pointed 
out to me the way to the museum, and also 
that to the lecture-rooms. 

In the museum I saw a very fine collection, 
illustrative of the materia medica — the finest, 
by far, that I have seen yet in Grreat Britain ; 
it appeared to be very complete. 

The operating theatre had no seats, being in 
that respect like that of Gruy's Hospital, which 
I have already described. The students all 
stand during the operations, being able to rest 
themselves a little by leaning against an iron 
railing, which is in front of every high step. 

Although my visit was not paid on the regu- 
lar operating day, yet I witnessed an operation, 
viz : the amputation of a cancerous mammary 
gland in a woman of api3arently about 60 years. 
The operator was Mr. Lloyd. 

In three places on the walls of the small 
room in which the operation took place, I ob- 
served, printed in large capitaJs, the most strict 
injunctions to preserve silence — injunctions 
which were followed, as far as I observed, by 
but one person in the room, and that one was 
the operator, who did not open his lips to give 
the least information about the case or the ope- 
ration. A dozen or two students attended the 
operation, and dejDarted immediately after it 
was over without waiting to see the dressing. 
I thought, probably, that the reason nothing 
was said about the patient was, that the stu- 
dents were already well informed about it, but 
it was not so, for one, to whom I put a question 
concerning the nature of the tumor, professed 
his entire ignorance of the case, only saying 
that he supposed it was carcinomatous ; and I 
found, from an observation of another student, 
which I was near enough to overhear, that Ke 
likewise knew nothing about it. 

The manner of administering the chloroform 
to the patient, was simply by pouring a mea- 
sured quantity on a rag and holding it just 
over the nose and mouth. What was appa- 
rently a little oil or glycerine was previously 
rubbed with the finger around the mouth, with 
the object, as I supposed, of preventing any 
irritation of the skin by the contact of the chlo- 
roform. 

As regards the dressing of the wound, the 
only thing which I observed remarkable was 
the great breadth of the strips of sticking plas- 
ter used, apparently nearly two inches wide. 
They were heated by tin cans of hot water, 
which custom has not been varied from where I 
have been, with the single exception of Edin- 
burgh, where they were heated by passing them 
close to a hot iron just removed from the fire, 
and so placed in a rest that the strips could be 
drawn rapidly close to it, and without any dan- 
ger of contact. 



November 3, 1860. 



NEWS AND MISCELLANY. 



125 



To-morrow I hope to witness some more ope- 
rations at tlie same hospital, on the regular 
clinic day. 

Very truly yours, 

M. D. Abroad. 



Schools in New Yoek — Dead House Lectures — 
Curious Case of Tubercular Deposit — Sani- 
tary Matters. 

New York, Oct. ZOih. 
The course of lectures in the medical schools 
of this city are now fairly under way, and, as 
far as can be judged at present, the classes are 
large. The College of Physicians and Surgeons, 
or, as it must now be called, "Columbia Medi- 
cal College,^' has a larger number of matriculants 
than it had at any session since its existence. 
The University Medical College is, I under- 
stand, similarly favored. Of the New York 
Medical College I cannot speak positively re- 
garding numbers, though with the energy of 
its faculty there seems to be a good prospect of 
success. 

In reference to the subject of medical educa- 
tion in this city, allow me to remark that the 
importance of clinical and hospital teaching is 
more and more appreciated, and great eftbrts 
are made to render the opportunities which the 
institutions of our city offer more available 
than they have been hitherto. 

I was very much struck with the improve- 
ments that have been made at the Bellevue 
Hospital. One of the most interesting features 
which I witnessed the other day, was what 
might be called a " dead house lecture." Pro- 
fessor Alonzo Clark, whose zeal in pathological 
research is too well known to need your cor- 
respondent's encomium, has been in the habit for 
a few years past of superintending the most im- 
portant autopsies in the presence of the stu- 
dents. While the autopsy is made by the 
assistants, the Professor keeps up a running 
discourse on the nature of the disease, demon- 
strating its morbid anatomy in the various pa- 
thological changes which the organs may have 
undergone. This enables the student not only 
to see for himself, but, under the guidance of so 
able a teacher, he readily acquires a knowledge 
of what to look for in autopsies — how to estab- 
lish a connection between symptoms and ana- 
tomical changes. It must be acknowledged 
that such a course cannot but be of immense 
value to the students, and I was pleased to see 
on my recent visit that it is appreciated by 
them. 

At the occasion referred to, quite a curious 
pathological condition was found in one of the 
autopsies. The patient had cirrhosis of the 
liver, with its usual concomitants of serous 
effusion in the abdominal and thoracic cavity. 
A few days before his death, he hadhadhsema- 
temesis, the result of obstruction in the portal 



circulation, the patient vomiting at one time 
nearly a quart of blood. 

The ascending colon was found firmly adhe- 
rent to the abdominal parieties by a patch of 
false membrane ; upon and within this adven- 
titious material, numerous tubercular masses 
were found deposited of various size. No tuber- 
cular deposit could be detected in the lungs 
or elsewhere. 

The points of interest in the case is the oc- 
currence of tubercle in a mass of adventitious 
false membrane, with apparently no tubercular 
diathesis, at least the absence of similar depo- 
sits in the lungs or mesenteric glands. 

It seems, then, that not only all the normal 
tissues of the body are liable to become the seat 
of tubercular disease, but that it may occur 
even in false membrane. 

In sanitary circles great efforts are made to 
secure the much-needed reforms in sanitary 
matters in the metropolis, and it is to be hoped 
that the disgraceful legislative briberies, by 
which the sanitary bill was slaughtered last 
year, will not recur. 

Otherwise there is nothing very stirring going 
on in medical matters. The medical profes- 
sion was, of course, represented at the Prince's 
ball, and on dit that one of the sons of Escula- 
pius, present, did the honors to the Duke in the 
most approved Windsor Castle style, and felt 
the pulse of His Highness. 

Yours, GrOTHAM, Jr. 



NEWS AND MISCELLANY. 



Dr. Carson^s Mode of Slaughtering Cattle. — About 
twenty years ago, my father, the late Dr. Car- 
son, took out a patent for a new method of 
slaughtering animals, based upon the physiolo- 
gical doctrines promulgated by him in his "En- 
quiry," published in 1833. Shortly after the 
patent was acquired, my father fell into bad 
health, and, as great prejudice against the me- 
thod existed, by the advice of my brother, who 
was then a rising young physician, although he 
quite approved of the principle, the patent was 
allowed to lapse, without his family deriving 
any advantage from it. Being so thoroughly 
convinced of the superiority of the meat killed 
by this mode, I have occasionally, since my 
father's death, had sheep, calves, lambs, and 
pigs slain in this way, and for nearly two years 
my butcher has constantly killed these smaller 
animals. I have not allowed him to attempt 
the slaughter of oxen, for which indeed he has 
not suitable tackle ; but this man now kills 
with the greatest facility the animals I have 
mentioned. Every one who partakes of the 
meat admits its superiority in flavor, in tender- 
ness and juiciness. It keeps longer than meat 
killed in the ordinary way, it cures admirably, 
and is without doubt more nutritious. A num- 
ber of scientific men in London have tasted it, 



126 



NEWS AND MISCELLANY, 



Vol. V. No. 5. 



and tliey have all expressed to me their great 
approbation of it, but I am not at liberty at 
present to publish their names. The first pro- 
cess in killing is bv collapsion of the lung, 
which can be done in from about twenty to 
thirty seconds, and immediately afterwards, to 
facilitate death, to destroy irritabilily by cutting 
the spinal cord. The animal dies immediately, 
and in the operation only a few drops of blood 
are lost, In dressing, the only blood which 
flows away is venous ; it is dark as pitch ; it 
soon coagulates and becomes a solid mass, and 
is perfectly free from serosity. About one-half 
more of the blood, and all the finer juices are 
retained by this process, than in animals 
slaughtered in the ordinary manner — in sheep 
perhaps three pounds' weight and in an ox as 
much as twenty. 

In seeing the butcher dress the animal, the 
inquiring and thinking physiologist will be 
particularly struck with the appearance of the 
bowels and viscera, the veins and arteries of 
which resemble red netted work, and which in 
the ordinary mode of slaughtering are perfectly 
blanched. The operation, though exceedingly 
simple, requires a little practice, and if attempt- 
ed by an unskilled person may end in failure. 
My butcher suspends the animal by the fore 
feet, the carcass being quite oft' the ground ; and 
the hind feet are fastened to a ring in the floor 
to keep the animal steady. He then makes an 
incision into the chest with a scalpel on each 
side, between the fifth and sixth ribs, after 
which you hear the air distinctly rushing into 
the chest. But in order to make the collapse 
as complete as possible, I have made the man 
use large elastic enema bags with a valve. The 
operation with him is now perfectly successful, 
and he never makes a mistake. I am not a medical 
man myself, and although well acquainted with 
the physiological views of my late parent, I am 
not able to discuss this subject with the eminent 
physiologists of the present day, but of the su- 
periority of this over the ordinary practice I 
have not the least doubt. — Lancet. 



The State of Health in Syria. — The Syrian cor- 
respondent of the New York World, under date 
of Beirut, Sept. 27, gives some interesting facts 
regarding the ill state of health in those regions, 
especially of the people at Damascus. They 
are crowded into houses without furniture, com- 
fort, or conveniences. The sickness among them 
has increased to a frightful degree, and is in- 
creasing to such extent, that the A. A. R. Com- 
mittee have taken up the subject of sending 
medical aid to Damascus as soon as possible. 
It is proposed to ask of the London Syrian Re- 
lief Committee donations of wift/ddnei' and apo- 
thecaries' apparatus, and obtain physicians 
from the Levant, if possible, to avoid the ex- 
pense of bringing physicians from England. 
The Greek government has sent out three phy- 
sicians to Syria to aid the sufl'erers, and it is 
hoped that one of them may be induced to go 



to Damascus. Dr. John "Wortabet, a native 
physician, and Dr. Meshullam, of Jerusalem, 
are also proposed for this service, and it is 
thought that the French commander will con- 
sent to detail at least one of the medical staff 
for a few months, to go to Damascus. The 
hospital in Beirut, under the charge of Dr. Van 
Dyck, has been fitted up and supported at a 
very moderate expense, and with the aid and 
experience of Dr. Meshaka, of Damascus, it is 
probable that a similar establishment may be 
prepared in Damascus, at a reasonable cost to 
the committee. 

The Turks have done absolutely nothing for 
the sanitary condition of Damascus, and even 
here in Beirut the Relief Committee are about 
employing twenty men to sweep the streets, as 
the government will not do it. Yesterday we 
were all shocked and amazed to hear of the in- 
creasing mortality among the refugees in Beirut. 
The government provided quarters in the quar- 
antine grounds for about 2,500 of the widows 
and orphans from Deir el Komr, and Hasbeiya, 
etc. Now we hear that out of 600 children who 
were in that company, about 100 have died! A 
committee has been appointed consisting of Mr. 
Cyril Grraham and Dr. Van "Dyck, to visit the 
quarantine at once, and report upon the con- 
dition of affairs, and, also, do what can be done 
to save those who remain. Rev. Mr. Ford re- 
ports from Sidon that, but for the vigilance of 
the Sidon Auxiliary Relief Committee, there 
would have been very great suffering among the 
Christian refugees under the care of the govern- 
ment in Sidon. Rev. Mr. Lyons writes from 
Tripoli that he is about starting for Baalbec, in 
company with Mr. Yanni, for the purpose of 
distributing charity furnished by the committee 
to the sufferers in that vicinity. 

The condition of the Damascanes now in 
Beirut is dej^lorable. They have been accus- 
tomed to every comfort, and many of them to 
the most luxurious living, and now they are 
lodging in old khans, packed together without 
beds or mats, and with little covering, and some 
of the ladies, who have visited their places of 
temporary abode, represent their condition as 
most wretched. Yesterday, Sept. 26, clothing 
to the value of eight hundred dollars, was dis- 
tributed to them, and the eagerness with which 
they crowded around the stand of the distribu- 
tors amounted almost to fury. 



Gas Leakage. — The leakage of gas under 
ground, which, in the city of London, has been 
receiving some sanitary consideration, is said 
to be becoming a similar evil in Philadelphia. 
The rendering of the general atmosphere un- 
healthy, making basement rooms uninhabita- 
ble, and causing the moisture of the soil to be- 
come corrosive fiuid, which destroys the water 
pipes, are some of the evils which, in London, 
have already appeared. 

The leakage in Philadelphia, in 1850, 
amounted to little over one per cent, of the 



November 3, 1860. 



NEWS AND MISCELLANY. 



127 



wliole amount made, and was 2,916,826 cubic 
feet. In 1858, it had risen to over 35,000,000 
cubic feet, or eight per cent, of the whole pro- 
duct. The following year the leakage had 
again nearly doubled, and is stated at 68,000,000 
of cubic feet, or twelve per cent, of the whole 
amount. It will thus be seen that the leakage 
is not increasing in proportion to the increased 
manufacture, but in a greatly faster ratio, so 
that in nine years it has augmented to twenty- 
three times the amount which escaped in 
1850. 

In the city proper of London, the leakage is 
stated at 25,000,000 cubic feet ; in the entire 
metropolis, at 386,000,000. Estimating the 
population of the English metropolis at four 
times that of our city, our leakage should be, to 
represent an exact proportion, 96,500,000, an 
amount which it will reach this year or next, 
so that we have every prospect of seeing all 
the mischiefs which are now experienced in 
London repeated here. 

The remedy for this must be found in greater 
exactness of joints ; either much greater care 
must be exercised in carrying out the present 
mode of joining, or some entirely new system 
must be adopted. Apart from considerations 
of health, which are those which we would 
chiefly urge, let us look at the effect upon mu- 
nicipal expenses. 

It is asserted that the cost of producing gas 
amounts so nearl}^ to that obtained for it that 
reduction in price is impossible. The loss, 
therefore, of 68,000,000 cubic feet, at $2 25, is 
a loss to the city of $158,000 per annum. If 
the increase this year shows the same propor- 
tion as hitherto, the loss will amount to 
$300,000 for 1860, and go on rapidly increasing 
in future years. To this must be added a 
heavy expense, caused by deterioration of water 
pipes, the effect of which will probably become 
evident in a few years. 



Arsenical Waters. — A stream called Whitbeck, 
in England, rising in the Blackcombe Moun- 
tains, in West Cumberland, contains arsenic in 
determinable quantity. The arsenic is most 
puobably derived from veins of arsenical cobalt 
ore, through which it percolates ; for a few yards 
above the source there is the entrance of a mine 
which is very rich in arsenical ore. The arseni- 
cal water is habitually used for every purpose 
by the inhabitants of the little village of Whit- 
beck, and with beneficial results so apparent 
that one might be justified in paradoxically cha- 
racterizing it as a very wholesome poison, the 
deadly elements in dilution being productive of 
the most sanatary effects. Ducks will not live 
if confined to the Whitbeck, and, while trout 
abound in all the neighboring rivulets, no fins 
are ever found in the arsenicated stream. But 
its use by the villagers does not give rise to any 
symptoms of arsenical poisoning, but rather to 
the effects which are observed in Styria among 
the arsenic-eaters there. When the railway 



was being carried past Whitbeck, the first use 
of the water produced the usual marked eftects 
on the throats both of the men and horses em- 
ployed on the works. The soreness of mouth, 
from which they at first suffered, soon, how- 
ever, disappeared, and the horses soon at- 
tained the sleakness of coat assigned as one 
of the effects produced by the administration 
of minute but repeated doses of arsenic. It is 
a question how far the rosy looks of the Whit- 
beck children, and the old age which a large 
proportion of the inhabitants of the village 
attain, are to be attributed to the arsenic pre- 
sent in the water. 



Vacancy. — The lamented death of the late Dr. 
John Wiltbanks, formerly Professor of Obste- 
trics and the Diseases of Women and Children 
in the medical department of Pennsylvania 
College, has created a vacancy in the obstetrical 
staff of the Episcopal Hospital, which, we pre- 
sume, the energetic Board of Managers will fill 
at an early period. The new building, which 
has been under contract since early last spring, 
and which is in the Norman style of architec- 
ture, " modified to suit the purpose and charac- 
ter of the edifice," is rapidly progressing, and 
will be, when completed, the largest and best 
arranged hospital in this city. Its outline is 
in imitation of the " 'PsLYismii Hdpital Lariboisiere, 
of European celebrity." The length of the en- 
tire building will be two hundred and fifty-eight 
feet ; its greatest depth about two hundred and 
fifty-six feet, and portions of it will be three 
stories high. This institution, when fully en- 
dowed, (which, from present indications, it pro- 
mises soon to be,) will be an enduring monument 
to the philanthropy and liberality of the meni- 
bership of the church under whose auspices it is 
established, and will be highly ornamental to 
that section of the city where it is located. 

Under these circumstances, the position va- 
cated in its obstetrical staff cannot fail to com- 
mand the services of the best men in the pro- 
fesssion. 



Ball and Banquet in aid of the '^Jews^ Hospital.'' 
— The Directors of the Jews' Hospital in New 
York, which is situated at Nos. 138 and 140 
West Twenty-eighth street, held a banquet and 
ball which took place Tuesday evening, at 
the City Assembly Eooms, No. 446 Broad- 
way, at'half-past 5 o'clock P. M., in aid of the 
funds of the hospital. The institution was 
opened for the reception of patients in June, 
1855 ; since which time over twelve hundred 
patients have been admitted, and the greater 
part of them treated gratuitously, without aid 
from State or municipal governments. The 
funds are now exhausted, and the directors 
took this mode to call upon their friends and 
supporters of the hospital for assistance. The 
festival yielded over $12,000. 



128 



NEWS AND MISCELLANY. 



Vol. V. No. 5. 



The Total Amount of ingesta and egesta for 
twenty-four liours is, according to Prof. Dalton, 
(Lectures on the Physiology of the Circulation, 
Amer. Med. Monthly,) not less than six pounds 
and a half, as follows : — 

*"\ Absorbed duricg twenty-four hours. 

Oxygen, .... 1.019 lbs. 

Water, 4.275 '' 

Albuminous matter, . . .340 " 

Starch, 590 " 

Fat, 220 " 

Salts, 056 " 

6.500 " 

Dischai'ged during twenty-four liours. 

Carbonic acid, . . . 1.535 lbs. 
Aqueous vapor, . . . 0.445 " 
Perspiration, . . . 1.965 '' 
Water of the urine, . . 2.020 *' 
Urea and salts, . . . .150 " 
F^ces, 385 '' 

6.500 " 



A. New Cure for Consumption.— J^v. Gruirette, of 
Lyons, has been recently engaged, at the Hos- 
pital de la Charite, Paris, in a series of experi- 
ments, testing the value of a new treatment for 
the radical cure of pulmonary consumption 
during the suppurative stage. The Paris cor- 
respondent of the Lancet says it " consists in 
the establishment of a fistulous opening through 
the integuments of the thorax and the pleura 
into the lung at the diseased part, and in the 
free admission of air into the cavity of the ab- 
scess, which at the same time discharges its 
contents externally.^^ Several cases have been 
experimented upon with favorable resuls. — Co- 
lumbus Revieio. 



Stearate of Iron. — This remedy has been found 
very useful by Eicord in the treatment of the 
sores with which his name is particularly asso- 
ciated. Some persons may wdsh to give it a 
trial in this country, so we extract the formula 
for its preparation :— Take of sulphate of iron, 
one part ; hard soap, two parts. Dissolve them 
separately in about three times the weight of 
water, and mix the solution. A greenish pre- 
cipitate is the result, which is separated and 
dried, and then melted by a gentle heat. When 
melted, it is spread on cloth, like an ordinary 
plaster. — Columbus Beview. 



Suppositories.— This form of medication, since 
the butter of cacao has been adojoted as its com- 
ponent material, has become very popular. 
Such suppositories, containing articles usually 
prescribed, as opium, morphia, tannin, santo- 
nine, etc., are kept ready made in great variety, 
or are prepared to order, by Mr. Hubbell, Chest- 
nut street, or Mr. Arend, at Eighth and Poplar 
streets, in this city. 



Bone-Setters in France. — A child of fifteen 
months, in the department of Mayenne, lately 
fell from its sister's arms and injured one of the 
lower extremities. A bone-setter was called in, 
who handled the limb rather roughly, declared 
the thigh-bone was broken, and that he had set 
it. He then tied a handkerchief, moistened 
with soap and water, round it, and promised 
to return in a fortnight, receiving 13^. for his 
trouble. The man, however, did not again 
make his appearance, and a regular practitioner 
being called in, he found large abscesses with 
the fragments of the femur projecting from them 
when opened. Several months were necessary 
to obtain union, with considerable shortening. 
The bone-setter was then sued by the father, 
and the verdict was as follows : — A fortnight's 
imprisonment, £8 fine, £40 damages, and the 
costs of the medical attendance upon the child. 
— London Lancet. 



Sir Humphrey Davy at Fault. — ^When it was 
first proposed to light London with gas, it is 
said Sir Humphrey Davy gave his opinion 
against its practicability, solely on the ground 
of the impossibility of keeping the joints of the 
pipes from leaking. This great chemist was 
very deficient in mechanical talent, and was 
seldom able to make a tight joint for his pneu- 
matic experiments ; hence the cause of his 
opinion. Faraday, who became his assistant, 
being an excellent mechanic, soon showed him 
how easy it was to make tight joints for gas- 
pipes. 



Episcopal Hospital. — At a late meeting of the 
Board of Managers of the " Hospital of the Pro- 
testant Episcopal Church ^^ in that city, A. Dal- 
las Bache, M. D., was elected Kesident Physi- 
cian for one year in the place of Dr. H. L. Til- 
ton, whose term had just expired, and with 
whose reports of a number of interesting cases, 
which occurred in that institution during the 
past year, our readers must be familiar. 



Homeopathy in France. — The Paris correspond- 
ent of the World newsj^aper says that a pro- 
fessorship of homoeopathy will probably shortl^*" 
be established at Lyons and in the other medi- 
cal schools, through the " benevolent 'Mnter- 
ference of the Empress Eugene and her husband. 
There will be no such thing. The idees Napo- 
leoniques are anything but infinitesimal. 



Albany Medical College. — We are glad to learn 
that this school is in a flourishing condition. 
It has an excellent corps of professors, who are 
devoting themselves with earnestness to the 
work of teaching. There is connected with it 
a very excellent museum, one that wall com- 
pare favorably with those of the larger schools 
of our principal cities. 



NOYEMBER 3, 1860. 



NEWS AND MISCELLANY. 



129 



'■'■BcdlnetV^ Lives. — A life-assurance office de- 
clines an offer of business when not quite satis- 
fied regarding the present health or general 
constitutional condition of the person offering 
it. Practically, perhaps a fifth, or even a fourth, 
of the persons applying to get their lives in- 
sured are unable to stand the investigation 
miide into their state of health, and become, 
accordingly, "declined lives.^^ We find that one 
of the greater offices — the Royal — of which the 
central seat is, we believe, at Liverpool — has 
lately instituted an inquiry into the subsequent 
history of a large proportion of its "declined 
lives," and ascertained that their mortality, as 
compared with that of the accepted, has been 
for ages between 30 and 40, in the ratio of 34 
to "896, or about 3J to 1. Had the lives of that 
kind rejected during the last five years by the 
Eoyal, been accepted, the mortality would have 
been 225 per cent, in excess of the tables, and 
the claims 319 per cent, above the' amount ex- 
pected ; by which, of course, the accumulations 
made by the healthy would have suffered a 
serious deduction. — Chambers^ Journal. 



Elevated Playgrounds. — The difficulty of ob- 
taining sufficient area for grounds for recreation 
of the children at the English parochial schools 
has suggested the idea of constructing play- 
grounds on the roofs of buildings. This has 
actually been successfully accomplished in the 
parish of St. Giles, which is the most crowded 
and unhealthy part of London. The idea, 
although at first startling, seems to be really a 
very practicable one, and is perhaps applicable 
to private residences, as well as crowded 
schools and asylums. The atmosphere of a 
city is certainly purer at an elevation, and, with 
proper precautions for safety, the pale and 
cachectic inhabitants of eleemosynary institu- 
tions, and the toiling thousands in factories 
might thus have a convenient opportunity of 
enjoying exercise with the blessings of sunshine 
and fresh air. 



Physical Influence of the Metals. — The British 
and Foreign Medico Chir. Review, in an article on 
the action of medicines on the mental faculties, 
says, that " arsenic has a tendency to induce 
depression of spirits, while the preparation of 
gold serves to elevate and excite them.^^ 

We believe that the best way of preparing 
the latter for raising the spirits is by coining it, 
•and thus influencing the circulation, and that 
the former is more frequently and unfortunately 
the resort for obtaining a perpetual quietus to 
low spirits than a cause of the depression. 

It is said that invalid soldiers, who have lost 
their arms in battle, abound so in Paris, that 
an old woman makes a living in winter by going 
about wiping their noses for them. She calls 
herself Mouchese des Invalidcs. She does a thri- 
ving business in chilly, windy weather, but has 
dull times when it is pleasant. 



Asylum for Inebriates. — The Medical Society 
of Virginia have appointed a committee to ap- 
ply to the next Legislature of that State for a 
charter for a house of refuge for inebriates. 
There are only three similar institutions in the 
United States, one of these is located in Boston, 
and has been in operation for three years past i 
one in Baltimore, and one now building in 
Binghampton, N. Y., toward the completion of 
which the Legislature of that State has appro- 
priated $150,000. When we are to have a simi- 
lar institution here, does not seem very appa- 
rent. Our " House of Correction,'^ which, when 
built, will probably embrace wdthin its charita- 
ble folds, the poor inebriate, has as yet no vi- 
tality. 



Third Dentition.— Ml. Carre recently reported, 
at the Societe de Biologic of Paris, the case of 
a woman, aged eighty-five, in remarkably good 
health, who after experiencing some pain in the 
gum had a left upper canine tooth to appear. 
At intervals of some months, the second incisor 
on the left side of the upper jaw, and the first 
bicuspids in the upper and lower jaws, on the 
right side, appeared. 



London Orthopaedic Hospital. — At the half- 
yearly Court of Governors, it appeared, from 
the report, that the number of patients admit- 
ted during the half year was 778. The funds 
were still inadequate, and 200 cases were wait- 
ing admission. The mortgage debt of £6,000 
entailed an annual charge of nearly £300. 

Another Harmless Ingurgitation of a whole Ho- 
moeopathic Pharmacy. — The children of an inhabi- 
tant of Erfurth, in Germany, having discovered 
their father's homcEopathic pharmacy, swallow- 
ed all the globules of opium, arsenic, belladonna, 
&c., without the least unpleasant effects. 



/Suicide. — A most curious case of suicide oc- 
curred recently at East Flamboro, C. W., a 
man burning himself literally to death, by sit- 
ting on a burning pile of sticks. He was at 
the time insane. 



Medicated Vapor Baths. — Practitioners will 
notice, by an advertisement, that an establish- 
ment for administering sulphur and medicated 
vapor baths exclusively to females has been opened 
in this city. 



In an essay on Artificial Lactation, read be- 
fore the Indiana State Medical Society, the sub- 
stitution of sugar of milk for ordinary sugar in 
the preparation of cow's milk for infants is re- 
commended. 



A Nut for the Credidous. — The Dublin Medical 
Press says that rheumatism may be kept at bay 
for any length of time by carrying a little bottle 
of quicksilver in the breeches pocket. 



130 



NEWS AND MISCELLANY. 



Vol; V. No. 5. 



Births and Deaths in New York City. — If tlie 
official returns of births in New York are cor- 
rect, they are scarcely in excess over the deaths. 
On the 1st of June last, Col. Delavan, City 
Inspector, commenced keeping a record of 
births and marriages occurring in this city. As 
returned to the City Inspector's office, the num- 
ber of births since the 1st of June has been as 
follows : — 

June, 1,323 

July, . , . . . . 1,225 

August, 1,273 

September, . . . . . 1,333 



Total, 



5,153 



The average number of births, according to 
those returns, is 1,288 per month ; while, ac- 
cording to the pulDlished mortality statistics, 
the deaths average about 1,200 per month, 
which does not include the still-born. It seems 
from these data, (which, for humanity's sake, 
we hope to be incorrect,) that the growth of New 
York is entirely due to influx from without, 
which, if shut off, would at once lead to an 
actual decrease in the population. It is im- 
portant that light should be thrown on this 
important matter, and nothing but a stringent 
registry law can accomplish this. 



The Catalogue of the Atlantic [Ga.) Medical Col- 
lege shows 159 matriculates for the session of 
1860, and 59 graduates for 1859. 

The Catalogue of the St. Louis Medical College 
for 1860 shows 146 students and 51 graduates. 

Dr. Hayes' Expedition. — The Arctic exploring 
expedition, under Dr. Hayes, has safely ar- 
rived at Upernavik, in Greenland. The intel- 
ligence was received through the U. S. Consul 
at CoiDenhagen. 

QuacTc Advertisements. — A few days ago two 
quacks in this city were arrested, and bound 
over on a charge of circulating indecent pam- 
phlets. 

The Inquirer improves the opportunity to 
make the following sensible remarks in its edi- 
torial columns : 

"We are glad to see that at last a movement 
has been made towards arresting this loathsome 
practice ; and we sincerely trust that if guilt 
can be brought home to the parties now under 
arrest, condign punishment may cause them at 
least to hesitate before they again seek to enrich 
themselves by corrupting the health and morals 
of society. 

" What we particularly wish, however, to 
call public attention to at present, is the fact 
that there are respectable newspapers in this 
and other communities willing to publish, as 
advertisements, copious extracts from the very 
books which have just brought their authors 
and circulators into intimate acquaintance with 



the criminal jurisprudence of the country. It 
is rather inconsistent, after reading a column or 
two of vapid morality, printed in very bad type 
and on very dirty paper, (as though to drive 
readers away from what the journalist esteems 
a formal concession to the prejudices of so- 
ciety,) to find in another portion of the same 
paper the revolting advertisements of quacks, 
spread with all the attractiveness that large 
type and prominent positions can give them. 
We have no intention to palliate the offence 
with which these people are charged, and regret 
much that the progress of judicial refinement 
has done away with the pillory and whipping at 
the cart's tail for such reckless disregard of 
public morality. But, whatever may be the 
punishment meted out to vulgar, ignorant, and 
depraved men offending in this way, it should 
be much more severe for those journalists, who, 
without the quack's excuse of brutal ignorance, 
distribute, for the sake of a few dollars, a thou- 
sand copies of the pollution, to every one, 
which, without their aid, would ever be suc- 
cessfully brought to public attention." 
To all of which we sav amen! 



Free School for the Blind. — Through the efforts 
of Dr. Byron Morrill a free school for the 
blind has been established in Maine. Dr. M. 
has visited all the institutions for the blind in 
the United States, and confidently believes, from 
close observation and experience in the matter, 
that the system of educating these children may 
be greatly improved upon ; also the expenses 
greatly diminished. He has succeeded, by pri- 
vate donations, in establishing the school, and it 
is to be hoped that Government will assist in 
sustaining it. It is proposed to give the blind 
a good practical education, thereby enabling 
them to earn their own livelihood, either by 
some mechanical trade, or as teachers of music, 
for they are getting to be preferred as teachers 
of this science to any other class. 



Statistics of Imbecility. — It is estimated that in 
England and Wales there are not fewer than 
12,000 persons of all ages belonging to the im- 
becile class. Of these, 2,500 may be regarded 
as suitable subjects for school training: provi- 
sion exists for only 600. In Scotland, sjDecial 
inquiries have proved that there are about 3,000 
persons in the general class of imbeciles, and 
600 of these are assumed to be of a youthful age 
and capable of improvement : provision exists 
for only 36. In Ireland there were, in 1851, 
4,906 imbeciles ; for the educable portion of 
which no provision whatever exists. We have 
in England establishments at Eed Hill and at 
Essex Hall, Colchester : the former with 306 
inmates, and an annual expenditure of £16,000 ; 
and the latter with 30 inmates, and a revenue 
of £1,700. At Bath, also, an institution has 
been in operation on a limited scale, since 1846. 
In Scotland, an asylum for idiots has been es- 
tablished for some years at Baldovan, near 



November 3, 1860. 



NEWS AND MISCELLANY. 



131 



Dundee. In Edinburgh, the Society for the edu- 
cation of the Imbecile in Scotland has charged 
itself with the diffusion of information on this 
subject, and the furtherance of the work. The 
present provision for these unfortunates is la- 
mentably deficient, and contrasts unfavorably 
with the state of things abroad. Dr. Brodie, 
who is urging the case of the imbecile in the 
United Kingdom, points out that in Switzerland, 
France, Prussia, Austria, Bavaria, Piedmont, 
Denmark, and in six or more of the States of 
America, the State has charged itself with their 
care and treatment, and liberal provision has 
been made for their peculiar necessities. — Lancet. 



Absorption of Nitrogen hy Plants. — The investi- 
gations of Professor Pugh, of Pennsylvania, on 
the assimilation of gaseous nitrogen by plants, 
presented before the Scientific Convention at its 
late meeting, showing decisively that no assimi- 
lation of the free nitrogen of the atmosphere 
takes place, have been confirmed by a recent 
communication to the Chemical News, ("On the 
Sources of the Nitrogen of Plants,") by Dr. 
Charles Cameron, who is satisfied, from nume- 
rous carefully conducted experiments, that nei- 
ther the gaseous nitrogen of the atmosphere nor 
the combined nitrogen of humus can be assimi- 
lated by plants, and that the nutriment of plants 
can only be supplied by substances of a purely 
inorganic nature. In addition to the list of sub- 
stances capable of furnishing nitrogen to plants, 
(as urea, soda, cynanurates of potash, etc.,) he 
is, from some new experiments, able to add two, 
viz : nitrate of potash and ferrocyanide of potash. 
These investigations are of high theoretical and 
practical value. 



Arsenite of Copper in Dyestuffs. — Frequent use 
is made in the arts — as, for instance, in the 
coloring of certain stuffs, such as green gauze, 
green tulle, etc., and in the making of artificial 
flowers — of a very dangerous chemical, namely: 
arsenite of copper. Accidents having resulted 
from the use of these fabrics, and complaints in 
consequence having reached the French Minis- 
ter of Commerce, he has just addressed a circular 
to the various Prefects, instructing them to keep 
a watch over manufacturers which employ arse- 
nite of copper, and warning manufacturers that 
severe punishment awaits all who put fabrics 
into commerce whose use may be followed by 
ill effects. 



Naval Hygiene in France. — A Chair of Hygiene 
has just been founded in the Naval Medical 
School of Toulon, the first occupant being M. 
Roux, Surgeon-in-chief of the Imperial navy. 
Now that a Military Medical School has been 
established at Chatham, the next question will 
be whether we shall go on imitating our neigh- 
bors, and think of the formation of a Naval 
Medical School. There would be nothing 
strange in this, seeing that England is the first 
maritime power in the world. — Lancet. 



The following " Frog-Story^^ is going the rounds 
in the papers: A writer in the Norwalk (0.) 
Reflector, describes a visit which he paid last 
month to a lady at Toledo, Ohio, who takes six 
live frogs as a remedy for consumption. She 
was recommended to do it by an Englishman, 
who said he was cured in that way. In six 
weeks this singular medicine has restored her 
from a state of great weakness to strength. 
The visitor saw the lady take a live frog from a 
jar, and swallow him whole, without chewing. 
Her daughter also did the same. 



Accidental Poisoning hy Arsenic. — Three men in 
the employ of Messrs. Crum and Thernliebank, 
of Grlasgow, boiled some potatoes in a dish used 
for the purpose of lifting a liquor employed in 
some process of bleaching. The three men 
having eaten heartily of the potatoes, were 
seized with violent pain and vomiting, but ulti- 
mately recovered. It appeared that the liquor 
for which the dish had been used, contained a 
large quantity of arsenic and chlorate of potash, 
with which the potatoes had been impregnated. 
— Dublin Press. 



An Operation upon an Operator. — M. Stackler 
enjoyed great reputation at Mulhouse, in France, 
as a cool and skillful operator, and also as the 
author of several talented medical works. M. 
Stackler, unfortunately, suffered from a fibrous 
tumor of the rectum, and underwent the opera- 
tion for artificial anus, soon after which he died 
of consecutive peritonitis. 

At Capeaho, Chili, is a woman thirty-six years 
of age, who has been twice married, having 
during the nine years of her first marriage thir- 
teen children, and during the eleven years of 
her last, fifteen children. Her husband works, 
but she has to beg in order to aid him in sup- 
porting the household. 



According to the experience of Dr. Hutton, the 
flight of a cannon ball was 6,700 feet in one- 
quarter of a minute, equal to five miles per 
minute, or 300 miles per hour. It follows, 
therefore, that a railroad train going at the 
rate of 75 miles per hour, has the velocity of 
one-fourth that of a cannon ball. 



Sir Benjamin Brodie. — Although the operation 
of iridectomy on this distinguished physician 
failed, he is reported to be able to walk out 
without a guide, and is at present visiting a sea- 
side watering place. 

Diphtheria is said to prevail with great fatality 
in various parts of Northern Illinois — in La 
Salle, Kane, Stephenson, Winnebago, and Du 
Page counties. 

A Case of Successful Treatment of Tetanus by In- 
dian Hemp is reported in the Lancet by Mr. Far- 
rage. Thirty drops of the tincture were given 
every two hours. 



132 



ANSWEES TO COEEESPONDENTS. 



Vol. V. No. 5. 



At Cambridge, [Eng.,) the candidates for medi- 
cal degrees are required to satisfy the exami- 
ners in the following subjects: Hippocrates: 
the 1st, 2d, 3d and 4th sections of the Aphorisms. 
Aretseus: the first five chapters of the 2d book 
of the " Causes and Symptoms of Acute Dis- 
eases.-'^ Celsus : the 2d book. 



The Medical Schools of Cincinnati opened their 
sessions on the 22d and 23d ult. In the Medi- 
cal College of Ohio, the introductory lecture 
was delivered by the Dean of the Faculty, Prof. 
M. B. Wright, and in the College of Medicine 
and Surgery, by Prof. B. S. Lawson. From the 
Lancet and Observer we learn that the former 
opens with about sixty, the latter with about 
eighty matriculants. 

Tlie Atlanta Medical College closed its sixth 
course of lectures on September 1st, after a pros- 
perous session. The degree of M. D. was con- 
ferred upon sixty candidates. 



Ether and Chloroform. — The profession in 
Lyons, France, have resolved to abandon chlo- 
roform and use ether as an angesthetic, because 
the latter is less dangerous, and though per- 
haps less convenient, as efficient as the former. 



J. M. — Four Resident Physicians to the Philadel- 
phia Hospital are elected every year, shortly after 
the close of the College Sessions. An application 
should be sent to the Office of the Guardians of the 
Poor, No. 42 N. Seventh street. 

J. G, — The hypodermic syringe may be had from 
either Gemrig, Kolbe, or Helmbold, surgical cutlers. 
Its cost is $3.50. It can be sent by mail. 



MARRIAGES. 



A United Society of Chemists and Druggists has 
been formed in England recently, and has 
already many members. The Chemist and Drug 
gist, a monthly trade circular, seems to be the 
official organ of the society. 



Dr. D., Penna. — We are sorry that our terms 
discommode you. There can be no ground of com- 
plaint, however, as they are fairly announced in our 
Prospectus. The terms were not made for you, but 
for all who may deem it of advantage to them to 
support our enterprise ; and the system of advance 
payment was adopted and insisted upon, in the belief 
that it will be the most economical for all parties 
concerned. We base our expenditures on the expec- 
tation that all our subscribers will comply with our 
terms in this respect, and when we find that any of 
them are indisposed to do so, we can only take it 
for granted that the work is not wanted, and there- 
fore cease to send it. We have the satisfaction, 
however, of generally finding, as in your case, that 
subscribers yield gracefully to our terms, so that 
we lose very few. It is our aim to make the Re- 
porter a desideratum to the profession ; and if we 
do so, no one who desires a good journal will be 
"willing to do without it. 

E. D. — It is not customary now to render medical 
services by contract for a certain sum to be paid 
annually, irrespective of the amount of service re- 
quired. There is nothing in the regulations of any 
medical society, that we are aware of, which alludes 
to the matter. Every practitioner has a right to 
make such arrangements, if he chooses to do so, but 
the practice is not considered creditable in this city. 



Brooke — Morris. — On Thursday, Oct. 25th, by 
the Rev. M. C. Lightuer, Dr. J. B. Brooke to Maria 
Wharton, daughter of Thomas Morris, Esq., all of 
Reading, Pa. 

Egbert — Phipps. — October 17th, by Rev. J. D. 
Howey, Dr. A. G. Egbert, of Cherry Tree, Pa., and 
Miss Eliza Phipps, of Clinton. 

Houghton — Hughes. — On the 25th October, in 
this city, by Rev. John Jenkins, D. D., Dr. Charles 
M. Houghton to Miss Mary M. Hughes, all of this 
city. 

Merritt — RowE. — In New York, October 24th, 
at the Church of the Messiah, by Rev. Dr. Osgood, 
Julia Teresa, youngest daughter of James Rowe, 
Esq., to J. King Merritt, M. D., all of New York. 



COMMUNICATIONS RECEIVED. 

Ntw ForX;— Dr. MacnichoU, (6,) Dr. G. C. Richards, (with end.,) 
Dr. A. P, Cook, (Avith end.,) Dr. A. Van Antwerp, (with end.,) 
Dr. J. V. Quackenbuch, (with end.,) Dr. Springsted, (with end.,) 
Dr. Atherly, (with end.,) Dr. W. H. Bigelow, (with end.,) Dr. 
T. B. Chamber s, (with end.,) Dr. H. Randie, (with end.,) Dr. S. 
Winnie, (with end.,) Dr. A. Shiland, (with end.,) Dr. H. B. 
Horton, (with end.,) Mrs. L. Covell. 

Pennsylvania— Mv. John Hulme, Dr. J. W. Eldred, (with 
end.,) Drs. Lichenshaler and McCormick, (with end.,) Dr. W. 
P. Rothrock, (with end.,) Dr. E. L. Lyon, (with end.,) Dr. S. 
PollodJ, (with end.,) Dr. T. Lyon, (with end.,) Dr. J. H. Roth- 
rock, (with end.,) Dr. T. Wood, (with end.,) Dr. L. F. Caldwell, 
(with end.,) John Hulme, (2,) Dr. J. H. Keeler, Dr. P. M. Zdgler, 
(with end.,) Drs. S. S. and R. S. Wallace, Dr. W. Anderson, Dr. 

D. W. Hoover, (with end.,) Dr. R. Armstrong, (with end.,) Dr. 

E. M. Horner, (with end.) 

Illinois— Dr. R. W. Crothers, (with end.,) Dr. A. P. Betters- 
worth, (with end.,) Dr. J. V. Goltra, (with end.) 

Indiana-'Dv. R. G. 'Brandon, (with end.,) Dr. B. F. Elder, 
(with end.,) Dr. M. P. Thomas, (with end.) 

Massachusetts— Dr. W. T. Brackett, (with end.) 

Michigan— Dr. H. L. Joy, (with end.) 

JYew Jersey— Dr. J. M. Bean, Dr. J. A. NichoUs. 

Ohio—W. E. Chapman, Dr. H P. Kay, (with end,) 

Ehode Island— Dr. S. W. Butler. 

South Carolina— Dr. H. M. Clarkson, (with end.,) Dr. E. W. 
Du Rose. 

Tennessee— Dr. H. M. Moore, (with end ,) Dr. D. Thompson, 
Dr. T. C. McNeill, Dr. J. L. Abernethy, (with end.) 
Vriginia — Dr. D. P. Reauey, (with end.) 

Office Payments.— Dr. Bishop, V. D. Miller, Dr. F. B. Fl/)re> 
[Mo.,] H. F. Lindley, T. C. Thompson, S. B. Detwiler, Dr. J. V. 
Tanartsdalen, [Pa.,] Dr. B. C. Waters, Dr. J. M. Leedom, [Pa.,] 
Dr. D. Huntington, H. C. Yarrow, Mr. Bushong, Dr. H. W. 
Brinton, [Pa.,J M. 0. Thompson, J. B. Morrison. By Mr. Swaine : 
Drs. Salmon, Wilson, Rachenberger, Parry, [Cal.,] Hart, Tay- 
lor, [N. J.,] Kitchen, Pierce, Halsey, Carter, Parsons, and Tho- 
mas. By Mr. Foster : Mr. Brallier, W. J. Scull, L. W. Thomas, 
D. G. Hetzell, E. G. Booth, Dr. F. Holcomb, W. M. Palmer, E, 
Duff, R. Myers, and E. J. Say. 



THE 



MEDICAL AND SURaiCAL REPORTER. 



WHOLE SERIES, 
NO. 212. 



NEW SERIEP, 



} PHILADELPHIA, NOVEMBER 10, 1860. { vol v me 



ORIGINAL DEPARTMENT. 

COMMUNICATIONS. 

Anatomy in its Relations to Medicine and 
Surgery. 

By D. Hates Agnew, M. D. 

Lecturer on Anatomy, Surgeon to Philadelphia Hospital, etc. 

No. 33. 
Oral Region {continued.) Movement — It is not 
uncommon to meet with persons who can only, 
after considerable hesitation, protrude the 
tongue from the mouth. This peculiarity is 
Been where there is high irritation or inflamma- 
tion of the meninges of the brain ; or it may 
attend any condition of vascular excitement in 
those of a highly nervous temperament ; or the 
organ may be thrust or darted out, and again 
quickly retracted. These movements are by 
no means favorable signs, and do very com- 
monly point to the existence of serious intra- 
cranial disease, in consequence of which there 
is a loss of control over the voluntary move- 
ments. If the tongue trembles when exposed 
by the patient, it indicates great debility. 
When it is protruded to one side, there is para- 
lysis of the muscles of the opposite. 

Moisture. — Naturally the tongue when exam- 
I ined, will be found covered with a moderate de- 
I gree of moisture. This is derived from both 
I the glandular apparatus oi the mouth and 
the lingual papillae. All fevers have, at some 
period of their course, a tendency to arrest the 
natural secretions of these parts. Some caution 
is necessary to be observed on this point. 
Should a patient have taken any liquids just be- 
fore the physician's visit, it may be moist from 
this cause. Or, again, there are some who habit- 
ually sleep with their mouths open ; others are 
compelled to do so from nasal obstructions, as 
where the latter cavities are blocked up by pro- 
11 



fuse secretions or polypi. In such cases the 
breathing being carried on through the mouth, 
the tongue will be dry. Into all these matters 
the physician should be careful to inquire. 
Grenerally speaking, a moist tongue will be re- 
garded as highly favorable in the progress of 
febrile disease. The lingual papillae from consti- 
tutional as well as local causes, exhibit a great 
variety of conditions, highly instructive under 
the general term of the coated ov furred tongue. 
These coats are formed by accumulations of 
the ordinary epithelium of the papillae, glued 
together and discolored by vitiated secretions. 
Should the surface be yellow, it is indicative of 
functional disturbance of the liver, and is ac- 
companied with little taste. The peculiar shade 
is formed by the coloring matter of the biliary 
secretion being eliminated from the lingual 
vessels. A very heavily loaded tongue is not 
to be unfavorably construed. A light scanty 
coating accompanying fever is to be viewed 
with much more distrust, as there seems to be, 
by general consent, in such examples som« 
latent, masked, morbid action insidiously at 
work. 

A dark tongue accompa«ies disease of a low 
type in which the great mass of the blood is 
profoundly altered in constitution, as in typhoid 
fever, the anginose and malignant varieties of 
scarlatina, &c. In such, the epithelia ad- 
here in flakes, and are mixed with altered 
blood corpuscles, imparting the dark appear- 
ance. Should the surface of the organ unload it- 
self of this superimposed mass, it not unfrequent- 
ly exhibits a red, smooth, glazed appearance. 
The papillae have lost their epithelial covering, 
and no exudation for their reproduction taking 
place for the time, the surface dries from eva- 
poration and want of mucous secretion. Such 
a state attends a low vitiality of the intestinal 
mucous membrane. 

There is a white coat which is somewhat 
peculiar in appearance, and termed the vilbxta 
tongue. The surface is closely beset with deli- 
133 



134 



COMMUNICATIONS. 



Vol. V. No. 6. 



cate, light-colored processes, turned toward 
tlie pharynx. The explanation consists in 
elongation of the filliform papillse and their 
brush-like epithelial appendages, which attain, 
under certain conditions, a more than usual 
length. The villous tongue is found associated 
with disordered stomach. Should this growth 
continue to a still greater degree, the surface 
seems to be covered with minute hairs, hence 
we have the hirsute tongue. 

In aphthous conditions of the mouth and, in- 
deed, in any low fever, vegetable growths may 
be detected sprouting abundantly from the ap- 
pendages of the filliform papillae, such as are 
figured in the cut (No. 31) copied from Kolliker. 
In the centre (a) the epithelial cells of the 
papillse are seen, encrusting which [h) are col- 
lected vast numbers of granules, constituting a 
soil, from which spring the filaments, which 
stand like bristles over the surface. 




In reference to the color some caution is to 
be exercised that we may not be misled. Thus 
the tongue may be dark colored from some- 
thing the patient may have eaten, commu- 
nicating a stain to the coating, as certain 
^berries, extract of glycyrrhiza, nitrate of silver, 
.&c.; or it may be dark from an abundant de- 
velopment of pigment granules ; or yellow 
from the use of tobacco, or mineral acids, etc., 
etc. A peculiar tongue is seen in gouty sub- 
jects, or such as have injured the mucous mem- 
brane of the stomach by over-feeding and 
drinking, as dyspeptics. The surface is tra- 
versed by furrows or fissures, as though the 
organ was cracked. This is due to the extra- 
ordinary development of the filliform papillse, 
and their cell processes in certain places, while 
in others they remain unchanged — the latter 
constituting the fl.oor of the trenches ; the former 



their sides. If such papillae be carefully dis- 
sected, they will be found to contain an in- 
creased amount of the submucous connective 
element, and are, therefore, in a condition of 
positive hypertrophy. 

There is also a fissured tongue, which occurs 
in the progress of low fevers, but which de- 
pends upon a difl*erent condition of the papillae. 
Here the papilla, covered by epithelial layers 
and glued to each other by vitiated secretions, 
become dry and split open, leaving cracks, 
which are made and deepened by the motions 
of the organ. 

Another characteristic tongue is seen in cer- 
tain of the exanthemata, as scarlet fever. A 
thin stratum of white coating is uniformly dis- 
tributed over the surface, whilst rising up 
through it, like a vegetation sprouting from the 
soil, are numerous red points ; these are injected 
papillas, — medi^, or fungiform. 

Mode of Cleaning. — The manner in which the 
tongue becomes relieved of these various unna- 
tural secretions is not without interest. When 
it begins to clean at the sides and tip, gradual- 
ly extending towards the middle and root, it is 
a favorable and desirable mode. If it takes 
place at irregular spots over the surface, it does 
not so clearly indicate^a cessation of diseased 
action. Should the surface be left after the 
disappearance of fur preternaturally red, there 
is still some unsubdued irritation lurking in the 
mucous membrane of some part of the alimen- 
tary canal. The last part of the organ which be- 
comes clean is the posterior, which retains its 
coat after a long time. This does not, I am 
disposed to think, imply that there still re- 
mains some constitutional state not entirely re- 
lieved, but is rather to be ascribed to the muci- 
perous glands, clusters of which exist near the 
root, and which, in a great many instances, be- 
come so implicated as to pour out a perverted 
secretion, which stains the cells of the adjoin- 
ing papillae. We are constantly witnessing a 
heavily-loaded tongue, especially over its pos- 
terior part in cases of tonsillitis, and indeed in 
almost all varieties of sore throat. In such 
cases it does not follow that the tongue is at 
fault, or that the phenomenon betokens a gas- 
tric or hepatic derangement, but simply that 
the follicular secretions adhere to and strain 
the papillae with which they come in contact. 

The muciperous glands are very prone to in- 
flammatory attacks. Should the slightest ca- 
tarrhal symptoms be present, they will hardly 
escape, though we may not be conscious of 



NOYEMBER 10, I860.] 



COMMUNICATIONS. 



135 



tlieir participation in the attack. The so termed 
mucous corpuscles are, in all probability, pa- 
thological products, or exudation cells on their 
way to pus. 

Physiologically considered, some of the pa- 
pillse are organs of gustation, and common sen- 
sation, as the medise and maximse, and others, 
as the minimae, from their density and firm 
structure, prehensile, as the lingual spines of 
certain animals. The sense of taste is most 
acute near the tip. 

The organ is very intimately associated with 
the stomach through the communications of 
the fifth and eighth pair of nerves. In this way 
the stomach may affect the tongue, or in its 
turn impressions made upon the latter may 
affect the stomach. In this way also we ac- 
count for the nausea and vomiting, which fol- 
low the introduction of some unpleasant sub- 
stance into the mouth. To avoid this, such 
substances should not be allowed to touch the 
anterior part of the tongue when the taste is 
most acute. 

The tongue may become the seat of ulcera- 
tion as in the aphtha of children, or of a specific 
character, as in syphilis or cancer. In syphilis, 
the ulcer spreads upon the surface rather than 
in depth. The cancerous ulceration manifests 
a predilection for the anterior part and near to 
the side. It is also preceded by marked indu- 
ration. 

The tongue having but little fibrous tissue in 
its structure swells very rapidly in certain in- 
flammatory exudations, as sometimes occurs 
from the sting of a bee, threatening suffoca- 
tions. Such cases suggest free incisions into 
its substance. 

Hypertrophy. — This condition is found occa- 
sionally associated with scrofula. There is in 
such cases plastic exudation and an increase in 
the fibrous constituent of the organ. 



On Diseases as Manifested Epidemically and 
Epizootieally in the United States during 
the Summer and Autumn of 1860. 

By M. L. Knapp, M. D., etc. 

Of Baton Kouge, La, 

Business connected with the dissemination of 
my work on the ''Origin and Laws of Epidem- 
ics," has given me an opportunity the present 
season of taking notice of some of the prevail- 
ing manifestations of epidemic and epizootic 
diseases in the United States, and of acquiring 
some facts that may interest the medical public. 



I speak of epizootic disease in connection with 
epidemics, for the reason that much agitation 
of the public -mind existed on this subject in the 
spring and summer, and because of the intimate 
association of cattle plagues with epidemics, 
pointing to a unity of causation, or, perhaps, 
better to say, a unity of origin — a unity in 
the essential nature of all diseases, whether in 
man or animals. 

To be sure, the tendency and direction of 
thought for a long time has been the other way. 
It has been the fashion, ever since the great 
Swedish naturalist led off in the classification of 
plants, for pathologists to classify the manifes- 
tations of disease hy symptoms, which, however, 
are never constant, but ever varying, and there- 
fore wholly inadequate to serve the ends of 
science, which require exactness. But more on 
this anon, if perchance it comes up. Suffice it 
to say here, that symptoms are not disease, and 
no classification of symptoms can make up a 
series of diseases. 

I devoted some attention to the investigation of 
the cattle distemper, called pleuro-pneumonia, 
that prevailed during the spring and summer in 
and around Philadelphia, and which caused so 
much alarm in Massachusetts, supposed to have 
been imported from Holland by Mr. Chennery, 
in some choice breeds of cattle brought over 
last year. I found it had been prevailing for 
two years or more, and had been epidemical 
among horses as well as horned cattle. I found 
a number of instances where it had broken out 
in herds in which no accession of new purchases 
had been made or strange cattle added to the 
herds, where, in fact, the disease had originated 
in cattle that had been raised on the farms, and 
had never been off or abroad, nor had ever 
mixed with any outsiders or strange cattle what- 
ever. This satisfied me that there was a gene- 
ral cause operating far and wide, throughout 
not only the United States, but Europe also, the 
source of the mischief in Mr. Chennery's im- 
ported cattle, as well as the herds of neat cattle, 
hogs, deer, etc., in the different States of the 
Union. 

This view is repugnant to the nosological 
dogmatism of the day, to be sure, but neverthe- 
less I believe it to be the only philosophic, ra- 
tional, scientific, or tenable ground. The dog- 
matism that holds that disease, as manifested 
in Mr. Chennery's imported cattle, was a specific 
thing, differing essentially from the lung-dis- 
temper prevailing in other parts of the United 



136 



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Vol. V. No. 6. 



States, is an assumption without a shadow of 
proof— an hypothesis that calls for several hun- 
dred different essential natures in disease. In 
fact there is no limit. This dogma runs its 
supporter into the manifest absurdity and fal- 
lacy of admitting a symptom to be a disease. 
When, therefore, the Philadelphia commis- 
sioners, sent to Massachusetts to throw some 
light on th e cattle distemper, offered their m eagre 
reports, and assumed or assented to the posi- 
tion that the pleuro-pneumonia prevailing in 
Massachusetts was not the same disease as the 
pleuro-pneumonia prevailing in and around 
Philadelphia, where more deaths had occurred 
by it than in all reported in the whole State of 
Massachusetts, save those killed by commis- 
sion, they made a regular blunder, doubtless, 
though sustained by the general sense of the 
profession perhaps. If we admit this dogma of 
a specific difference in disease, we ought to be 
consistent, and go with the current of homoeo- 
pathy into the further fallacy of specific reme- 
dies, or a remedy for every symptom. It is the 
fotindation of quackery. 

But, say the sticklers for this dogma, the 
Chennery cattle disease is very contagious, and 
spreads only by contagion. It is contagious, 
doubtless, and like the pleuro-pneumonia that 
has prevailed for two seasons in and around 
Philadelphia, is epizootical also. Epizootical 
disease has been prevalent, I find, in most of 
the Western and Southern States for two years 
past. Last year there was an epizootic among 
horses in Louisiana, in the form of pneumonia. 
Numerous cases occurred in and around Baton 
Rouge, (authority. Dr. Enders.) There has been 
an extensive epizootic this season in Mississippi 
and Louisiana among cattle in the form of 
ophthalmia, (authority. Dr. Gillespie, of G-re- 
nada, Miss., Drs. Garrett and Harvey, Canton, 
Miss., and Drs. Dearing and Enders, Baton 
Rouge, La.) But beyond this, there has been a 
prevailing predispositon to disease manifested 
among cattle in some parts that savors of ro- 
mance. A fact I learned in the stage while travel- 
ing in Illinois, from two Missouri drovers, stag- 
gers belief. If one of them had not been a phy- 
sician, and cognizant of the fact, I should have 
almost deemed them trying to impose on my 
credulity. It is a precious nut for the sticklers 
for the specific nature of diseases to crack. It is 
this: 

Droves of healthy cattle in passing from Texas 
through Missouri this season have infected nu- 
merous herds in the latter state before perfectly 
well, apparently! 



I found this fact corroborated in St. Louis, 
and that some counties in Missouri had sufifered 
losses from the death of stock in this way, to 
the amount of thirty or forty thousand dollars, 
Green county one of them. This county is near 
the south-west corner of the State. Sundry peti- 
tions were addressed by the suffering citizens of 
said counties to the Legislature of the State, to 
have the nuisance abated — the drovers from 
Texas prohibited from passing through the 
State. 

The disease set up in the herds of Missouri 

was a mortal fever ! a very fatal typhoid fever ! 

What was the specific contagion, let me ask, 

that passed from the healthy Texan herds to 

infect the Missouri cattle ? 

Will the dogmatists who hold to the specif e 
nature of the Chennery cattle disease please 
answer? I am investigating the Origin and 
Laws of Epizootics, going somewhat elabo- 
rately into the subject, as an Addenda to the 
third edition of my work on the Origin and 
Laws of Epidemics, and will be very much 
obliged to any pathologist who will explain this 
matter on the principle of a specie poison. I 
will be very much obliged to any medical con- , 
frere who will explain this law, and give a satis- 
factory solution of this fact. I hope to do so in 
the forthcoming edition of my work alluded to. 
If any body doubts the/ac^, I may be permit- 
ted to refer to the early records of the Philadel- 
phia Agricultural Society, for a parallel fact. 
Dr. Mease, in an elaborate lecture before the 
Society, in 1814, asserts that "cattle from South 
Carolina, driven north, infect the northern 
herds, though not sick themselves. This I can 
assert from my own personal observation." 
(See Memoirs of Phil. Ag. Soc. 1814.) 

The drovers, who were my informants of this 
singular fact in Missouri, stated expressly that 
the droves of cattle from Texas were healthy, 
and remained so, none of them fell sick. 

I arrived in Memphis about the first of Octo- 
ber, and found the dogs were running mad. It 
would, perhaps, be too strong an expression 
to say that rabies was epizootical, but the 
weather was very hot and dry, and much con- 
sternation prevailed on account of mad dogs. 

But there was an epidemic prevailing to a very 
great extent, viz : the dengue, Or break-bone fever. 
Here was the point I first encountered it. All 
over the South, south of Memphis, it has pre- 
vailed this autumn, in city and country, and 
Dr. Enders, of Baton Rouge, from which beau- 
tiful city I write this, informs me that he has 
recently received a letter from a doctor in 



November 10, 1860. 



COMMUNICATIONS. 



137 



Western Virginia, describing it accurately, 
and saying that it is prevailing there exten- 
sively. 

It made its invasion in Memphis in the latter 
part of August, under a high temperature, and 
the first cases were but a shade milder than 
the true yellow fever, which it may be said to 
be, in fact, or is declared to be by those who 
still hold to the old dogma of a plurality of 
diseases, only it is so mild that it rarely proves 
fatal. 

It is described as a fever of one paroxysm of 
two or three days duration, accompanied by 
the most intolerable and universal aching pains, 
and when the fever goes off there is left an ex- 
cessive prostration, from which the patient 
slowl}^ recovers in from ten to fifteen days. 

In Memphis, under a sudden change of tem- 
perature or sinking of the thermometer after 
rain, it took the form of a catarrhal fever or 
influenza, with congestion of the lungs, cough, 
bloated countenance, etc. I saw several cases 
of this description. 

In Baton Eouge, I have conversed with two 
doctors, an M. D. and a D. D. S., who have 
just convalesced from an attack of it. The 
physician, Dr. Patrick, went on to tell me, un- 
questioned, that his nose had kept bleeding 
more or less throughout the attack, and that 
his gums were so soft and spongy that he could 
suck blood from them at any moment, quite 
significant of its scorbutic pathology. In the 
dentist, the red line on the gums is very charac- 
teristic of the scorbutic diathesis. 

The way to treat it successfully is to bathe 
the feet in warm water, give warm lemonade, 
enjoin rest, and let the patient recover. Heroic 
drugging is getting out of vogue in the South. 

At New Orleans, this form of epidemic dis- 
ease has been excessively prevalent, and is still 
prevailing, but in all these southern regions it 
is now, (24th of October,) very much on the 
decline. 

The causes of this general manifestation of 
disease in men and animals are not obscure, it 
does appear to me. 

This has been an extraordinary season. The 
cosmical phenomena have been remarkable. 
The storms and tornados have been frequent 
and furious, the heat excessive, and the drought 
has cut short the crops and fruits in some loca- 
lities to the extent of a partial famine. In an 
especial manner have the cattle suffered from 
the burnt up state of the grasses, or, as has 
been expressed to me in localities where oph- 



thalmia has prevailed epizootically, "the cattle 
have been literally starved out.'^ The exility 
of good succulent grasses and herbage, as food 
for cattle, the excessive cold of last winter, a 
retarded spring, and a poor state of the crops 
and fruits, the food of man — in a word, the 
general causes that impair the nutrition of all 
animal life, lie at the bottom of the evil. The 
condition or essential nature of the evil is im- 
poverishment of the blood, or impaired nutri- 
tion. This dyscrasy is synonymous with the 
scorbutic diathesis ; it is identically the same. 
There is but one pathology, in reality, viz: 
impaired nutrition, a want, an unnourished 
condition. And but one physiological condi- 
tion, viz : a good and reasonably perfect state 
of nutrition. 

The cause of the remarkable constitution of 
the seasons by which the crops and fruits are 
abridged and deteriorated is probably attribu- 
table to the action of the sun or to solar heat. 
Meteorology has not yet arrived at so progressed 
a jDOsition that it can explain why the sun's 
action on the earth and atmosphere this year 
should produce the fitful and remarkable spasms 
and convulsions, and heats and droughts that 
have occurred, and leave us exempt from any 
such extremes another year ; but it is to be 
hoped that observations will yet perfect the 
science to such a degree, that we may be en- 
abled to see further back into the realm of 
causes than we now do. 



Belladoima— In Inflamed Mammae, Fauces, 
Etc. 

By J. W, Thompson, M. D., 

Of Philadelphia. 

This article has been much lauded, and I 
think deservedly, by some members of the pro- 
fession, while others consider it of but little value, 
except for its narcotic properties, which, of 
course, must succumb to opium, except in pecu- 
liar cases. Now, as a multiplication of expe- 
rience is the only true test in such cases,- I have 
concluded to record some things that I have 
noticed in the use of it. 

On the 9th of August last, I was called to a 
woman who had allowed an inflammation of 
the right mamma to proceed to suppuration. 
The orifice formed was about an inch and a 
half above the nipple, and was, and had been^ 
for several days, discharging pus freely. She 
was quite feverish ; bowels constipated ; and 



138 



COMMUNICATIONS. 



Vol. V. No. 6. 



suffering much pain, both in the breast and 
head. 

I ordered her a dose of the comp. cath. pill ; 
farinaceous diet ; and a solution of ext. bell. 9ij 
to f^j of water, to be applied freely three 
times a day to the inflamed breast, which was 
then to be covered with a light, bread and milk 
poultice, having a quantity of the chamomile 
petals added, a la Meigs. A suspensory bandage 
was, of course, directed, as the patient was up 
the greater part of the day. The next day she 
was better in every respect, but feeling weak 
and some nausea, (the result of the purgation, 
most likely,) she kept her bed.- The third day, 
her breast was very much better. The fourth, 
it ceased discharging pus, and soon afterwards 
the orifice was closed, kindly, by granulation. 
As she recovered, nutritious diet and iron were 
allowed her, she having been in rather an anae- 
mic state for some time prior to her attack. 

How much of this result should be attributed 
to the belladonna may be a question with some, 
but, at all events, I considered it a very satisfac- 
tory termination. On the 24th of October last, 
I was summoned, in haste, to the bedside of a 
patient who had given birth to a fine female 
child, under my charge, upon the 7th of the 
same month, and since that time she had been 
doing remarkably well. 

I found her with a high fever, slightly deli- 
rious, constipated bowels, headache, and, in- 
deed, complaining of pain nearly all over. Next 
to her head she complained of her abdomen, 
but, upon examination, I found it not at all ten- 
der to the touch. I then turned my attention 
to the mammae, but she said there was very 
little pain there then, although there had been 
some hours before. Upon my touching the 
upper part of the right one, however, she almost 
screamed from pain. There was a hardened 
mass here of nearly half the size of the palm of 
my hand, and over which the skin was already 
discolored, presenting anything but a desirable 
appearance. I ordered her a purgative dose of 
mag. sulph., and Norwood's tinct. verat. virid, 
in gtt. V. doses every hour, and the same local 
treatment as in the other case. In thirty-six 
hours she was relieved of nearly all untoward 
symptoms, and from that time rapidly re- 
covered. 

In both these cases the child was allowed to 
draw the breast frequently enough to keep it in 
a flaccid state, taking the precaution always to 
cleanse the nipple well first. 

I have not found the belladonna, used in this 



manner, to affect at all the secretion of milk, as 
some have observed; though whether it was 
because of use for a less time, or in weaker so- 
lution, or because it does not do so, such a coin- 
cidence only having accidentally occurred with 
some, I cannot, as yet, pretend to say. 

My experience with it in incipient sore throat 
would lead me to rank it almost as a specific, 
if used sufficiently early. My plan is to give 
the sixtieth of a gr. of atropia, and I rely upon 
it confidently if given within six hours of the 
first appearance of inflammatory symptoms. I 
have tried it repeatedly upon myself, as well as 
others, and yet have to note the first failure. 

After six hours, though, I have found it of 
much less advantage, and beyond twelve have 
even thought it productive of aggravation. 
This, of course, precludes its use to any great 
extent in practice for this purpose, because 
such cases rarely come under treatment before 
the second or third day, and it is too powerful 
a remedy to be thrown promiscuously into the 
hands of the public for domestic use. 

In resolving glandular tumefacl^on, especially 
of the neck, I have found, at times, both the 
atropia and the ordinary extract to act very 
promptly, the former, in a few cases, almost 
like magic ; nevertheless, it has not proven 
so universally successful with me as to war- 
rant, at all, the conclusion of its being spe- 
cific. For such instances I have used the ext. 
in solution as above, or the atropia in propor- 
tion of gr. j. to f^j, adding a small quantity, say 
a f 5- of alcohol, to favor the solution. 

The Homoeopathist gives belladonna in cer" 
tain affections in the healthy subject, and, conse- 
quently, will cure them when otherwise brought 
about ; but it has always been a query with me 
if the operation were not just the opposite of 
this, it being, in fact, a most intensely "Allopa- 
thic'' treatment. It is well known that it has a 
peculiar tendency to the throat — as much so as 
ergot has to the uterus — producing a dryness 
and constriction of the fauces, a change of voice, 
etc., but very different from any ordinary affec- 
tion for the relief of which it acts so benefi- 
cially. 

Is it not rather that its, peculiar and anodyne 
properties act as repellants against the determi- 
nation of fluids toward the inflaming tissue — a 
necessary part of inflammation — and by allay- 
ing the nervous excitement allowing the healthy 
action to be resumed, which in the incipient 
stage may readily be done, there having been, 
as yet, no effusion or change of structure; but, 



November 10, 1860. 



HOSPITAL PEACTICE. 



139 



at a later date, change having taken place, and 
the fires of inflammation glowing virulently, it 
ceases to be applicable ; perhaps from the dry 
surface produced allowing the atmospheric 
oxygen to come into ready contact with the su- 
perabundant blood and other fluids now pres- 
ent, and thus adding fuel to the flame. 

A blast of wind will readily extinguish the 
new-born blaze, but allow it a few moments 
existence, under favorable circumstances, and 
then all the winds of heaven will but add fierce- 
ness and fury to its life : and just as the fireman 
would now throw on torrents of water, instead 
of trying to blow out the fire, so the physician 
must change his tactics as inflammation ad- 
vances or takes on new forms. 



llWrntinns 0f JnHpital frattirt 



PENNSYLVANIA HOSPITAL. 

Service of Dr. Gerhard. 

In opening his course of clinical instruction 
during his present service. Dr. Gerhard made 
some introductory remarks on the importance 
of paying attention to the physiognomy of dis- 
ease. 

By studying the countenance and general ap- 
pearance we can often at once detect morbid 
changes, or conclude as to the seat of the dis- 
ease ; of course, however, this should never 
preclude from carefully examining into the con- 
dition of the patient by other means. 

First in regard to the complexion of the patient ; 
this, when sallow, indicates that the patient 
has been subject to malarious influence, and 
has either had or is going to have intermittent 
fever or some other form of malarious disease. 
When pale, it indicates ansemia, deficiency of 
the coloring matter in the blood. 

By marking the mode in which the patient 
breathes, we are often enabled to conclude with 
a considerable amount of precision as to the 
seat of disease. When he breathes with diffi- 
culty, when the nostrils are more or less dilated, 
we premise some aff'ection of the lungs or tho- 
racic organs. Whether this is primary, owing 
to morbid changes in the lungs themselves, or 
secondary, due to other causes, such as pressure 
upon the diaphragm, etc., must, of course, be 
determined by other modes of investigation. 
As a general rule it may be stated that the phy- 
siognomy of the mouth and nostrils marks to a 
certain extent the condition of the lungs. 

Disease of the brain is looked for in the ei/es, 
which in various forms of cerebral disease off'er 
a peculiar and characteristic expression. There 
is a peculiar aspect of the eye in delirium tre- 
mens, which none who has seen the disease will 



mistake ; in acute inflammation of the brain the 
eye is injected ; in other forms of cerebral dis- 
ease there is strabismus ; there is again in 
functional diseases, such as hysteria or mastur- 
bation, in which the brain is secondarily af- 
fected a peculiar restlessness of the eye, which 
is quite characteristic. 

In regard to the pulse, not so much import- 
ance is at present attached to it as formerly, 
when various kinds of pulse were minutely and 
systematically described. We have learned to 
examine the heart, and derive our knowledge 
of the condition of the circulatory system from 
its very source. 

In examining the limbs, it is important to 
notice whether there is oedema or not ; if it 
exists, it indicates dropsy. But dropsy, it must 
be remembered, is not a disease, but merely a 
symptom of disease, either of the heart, liver, 
or kidneys, or a combination of these. 

The development of the patient should be ex- 
amined ; whether there is emaciation or em- 
bonpoint. If the former is considerable, we 
suspect some slow chronic ailment ; if the latter, 
it often increases the violence of disease hj 
which the patient may be attacked. 

To make the student acquainted with the 
physiognomy of disease is one of the chief ad- 
vantages of clinical instruction, upon which we 
now enter. 



EMPHYSEMA OF THE LUNGS. 

This patient, about 35 years of age, is affected 
with difficulty of respiration. His complexion 
is somewhat pale, but not markedly so ; his 
nostrils are somewhat dilated, but do not act 
spasmodically. 

The patient was first taken with this diffi- 
culty of respiration in the summer, some seven 
or eight years ago. His case is one of so-called 
annual asthma, or annual catarrh ; properly 
speaking, however, it is emphysema of the lungs. 
It has also been called "hay asthma,^-* on the 
Continent, especially in England, because it was 
thought by some to be somehow connected with 
the mowing of hay. This, however, is not the 
case ; the fact being simply that the disease is 
more liable to occur in July or August than in 
other months, and it is merely a coincidence 
that this is the time of the hay harvest in Eng- 
land. In this country the disease occurs with 
probably equal frequency and during the same 
months ; yet the hay harvest here is generally 
much earlier. 

The disease then occurs particularly at those 
seasons when the weather becomes cool, and 
the contrast between the temperature of the day 
and night becomes marked. 

In the patient before us, the disease is not as 
well marked as we occasionally find it. For 
the last seven or eight years he_ has had an 
attack, once at least every year, with the excep- 
tion of last year, when he had none. His pre- 



140 



HOSPITAL PEACTICE. 



Vol. V. No. 6. 



sent attack came on about the middle of Au- 
gust, with much difficulty of respiration, cough- 
ing and expectorating a great deal. He entered 
the hospital on the 19th of last month. 

Physical Examination. — His chest is very little 
dilated. This is a point of some importance in 
emphysema. Where young persons are attacked, 
the thorax, yielding more readily to the expan- 
sive pressure from within, undergoes marked 
dilatation, while in patients who have passed 
the age of thirty-five or forty, two causes ope- 
rate more or less strongly to render this liability 
to expansion of the chest less. In the first 
place the ossification of the costal cartilages 
and the firmer position of the ribs after thirty 
or thirty-five, and, secondly, adhesions of the 
pleura to the lungs, which prevent the latter 
from expanding freely. For, there are scarcely 
five men out of a hundred, having reached the 
age of thirty-five or forty, who have not adhe- 
sions, more or less, of the pleura to the lungs. 
In this patient you see at once, on mere inspec- 
tion, that the right side is somewhat con- 
tracted. 

Percussion. — The percussion-sound on both 
sides is preternaturally clear. It is somewhat 
less so, however, on the right side, which is 
accounted for by the pleurisy which the patient 
evidently has had one time or other, and which 
is further indicated by the contraction of this 
side, already mentioned. The patient does not 
remember of ever having had pleurisy, or even 
pain, in the side. But this is no criterion what- 
ever. If you take twenty persons, having pleu- 
risy, you may find twelve to sufi'er no pain 
whatever and who are scarcely aware that any- 
thing serious is the matter with them ; while in 
two the pain is probably slight, and in the other 
six of a most severe, acute, and agonizing cha- 
racter. The fact, then, that this patient is igno- 
rant of having had pleurisy does not exclude 
its existence. 

On auscultation there is a feeble respiratory 
sound. There is not the natural vesicular ex- 
pansion ; the expiration is also slight. 

You must take care not to confound the ex- 
piration of emphysema with that of phthisis. 

When this patient came into the house first, 
he had a slight sonorous, but no mucous ron- 
chus. But this has been diminishing, until at pre- 
sent there is none at all, showing that the par- 
oxysm is gradually passing oft". 

The treatment of this case has been simply 
tonic ; quinine and iron are the remedies that 
have been relied upon. 

H^MATEMESIS CHRONIC DYSPEPSIA. 

This patient is a woman about thirty years 
of age, who tells us that from her infancy her 
stomach has been in a bad condition ; having 
always been troubled, more or less, with dys- 
pepsia. Notwithstanding this, she digested and 
assimilated her food sufficiently to reach a tol- 
erably good state of health. ■^ 



Five weeks ago she had an attack of haema- 
temesis, which lasted for three days. The pre- 
cise quantity of blood vomited cannot be accu- 
rately determined. Patients are exceedingly 
liable to overrate the quantity of discharges of 
this kind. Yet in her case it is fair, perhaps, 
to presume, from her statements and the exsan- 
guinated, anaemic, pale countenance, and pros- 
trated condition which she presents, that the 
amount of blood lost, was not inconsiderable, 
— from a pint to a quart. 

There was no severe pain accompanying the 
hsematemesis ; she only had slight headache, 
felt weak, and after the first paroxysm had a 
great desire for cold drinks. She vomited more 
or less blood during the three days after the 
first attack, but there was no persistent nausea 
accompanying the vomiting. Occasional at- 
tacks recurred until three weeks ago, since 
which time they have entirely ceased. 

To determine the cause of this hsematemesis, 
we first examine the stomach. Here we find 
very little alteration. On percussion over the 
stomach, there is the natural clearness, which 
increases as we ascend to the cardi.ac orifice, 
because here there is nothing but air, on ac- 
count of the position of the patient. While no 
tumor or hardness whatever can be found in 
the stomach, its cardiac orifice, or the pylorus, 
the liver also, is in a normal state, it being nei- 
ther enlarged nor diminished in size ; nor is 
there any enlargement of the spleen. These 
signs, then, are all negative. 

The patient has had no suppression of her 
menses, which might have caused the discharge 
of blood from another part, as sometimes hap- 
pens, constituting what is called vicarious men- 
struation. 

Another evidence of the non-existence of can- 
cerous disease, beside the absence of any tu- 
mor, is her general aspect, which is not that so 
peculiar to cancerous disease ; there is no ema- 
ciation. 

Being obliged, then, to exclude suppression of 
the menses, cancer of the stomach or pylorus, 
disease of the liver or spleen, obstructing the 
portal circulation, and causing mechanical ex- 
travasation of blood, as the cause of hasmate- 
mesis in this instance, there remains no alter- 
native but to look upon it as simply hemor- 
rhage from the stomach, in consequence of 
chronic dyspepsia, from which the patient has 
suffered ; a simple hemorrhage, such as takes 
place from the nose in epistaxis. 

In examining the heart, we find the usual 
ventricular bellows sound, such as is peculiar 
after considerable hemorrhage, or in anae- 
mia. 

The treatment in this patient should be first 
to regulate her diet. She ^should eat such 
things as are easily digestible, but do not form 
a large mass, and in a liquid form, if possible. 
Milk and arrow-root, beef-essence, crackers 



November 10, 1860. 



HOSPITAL PRACTICE. 



141 



broken up in water or beef-essence, are suita- 
ble articles. 

Internally she has been taking one-quarter of 
a grain of opium, with two grains of tannin 
every three or four hours, which will be con- 
tinued for the present ; and, as her bowels have 
been rather costive, emulcent injections should 
be resorted to. 



UNIVERSITY OF PENNSYLVANIA. 

MEDICAL DEPARTMENT. 

Service of Prof. Pepper. 

PHTHISIS RHEUMATISM OF THE SHOULDERS. 

A woman, 30 years of age, married, mother of 
three children, came to the clinic for treatment. 
Her children, the youngest of whom is three 
years old, are all healthy. Her mother died of 
consumption when 22 years of age. 

The patient dates her present illness eight 
months back, when she was attacked with 
cough, expectorating about a teaspoonful of 
purulent matter. She had at that time a pain 
in the left side, low down. When lying down, 
she perceives a crackling noise in her larynx. 

The patient coughs much after getting up in 
the morning ; she has lost flesh and strength ; 
at the commencement of her sickness she had 
chills almost daily ; her catamenia have ceased. 

On percussion, slight dullness is found under 
the left clavicle, with some blowing respiration; 
there is some crackling when she coughs ; ex- 
piration is prolonged on the same side. 

From the rational and physical signs in her 
case, there can be no doubt that the nature of 
her difficulty is tubercular deposit commencing 
to soften. The disease was ushered in, proba- 
bly, ei-ght months ago by pleurisy, as is often 
the case ; for the auscultatory and percussion 
signs indicate that the lower part of the left 
lung is bound down by adhesions. 

There is a point of considerable practical im- 
portance in tuberculosis, connected with the 
comfort and sleep of the patient. When you 
have a cavity formed, or about forming, the pa- 
tient can sleep very well lying on the side on 
which the cavity is located ; but as soon as he 
turns over on the other side severe cough and 
dyspnoea at once occur. Why is this ? During 
sleep, there is an accumulation of the muco-puru- 
lent secretions in the cavity. So long as the pa- 
tient lies upon the sick side, the fluid gravitates 
downward ; but when he turns over, or lies on 
the spund side, it passes through the fistulous 
openings, which generally exist, into the bron- 
chi, and thence into the trachea, there obstruct- 
ing the respiration more or less, and thus bring- 
ing on dyspnoea and cough. The same is true 
of pleurisy, when there is effusion on one side. 

It is especially in infants that this fact should 
always be borne in mind. They have no power 
to change their position, and cannot expecto- 



rate. Hence when attacked with pulmonary dis- 
ease, and th ey are laid upon the healthy side, the 
most distressing symptoms of dyspnoea, and even 
asphyxia may occur, which, however, soon pass 
off" when the position is changed. 

Another point. The nostrils are the proper 
external organs of respiration, the mouth being 
supplementary. In children, who are suff'ering 
from catarrh of the nose, or any disease ob- 
structing the nostrils by secretions, which often 
become baked up into hard masses, as sordes 
in typhoid fever, scarlatina, etc., frequently you 
will be summoned in great haste, because, 
during sleep the child becomes blue in the face, 
with all symptoms of approaching asphyxia ; 
but as soon as the child is awakened and taken 
out of bed, this condition is relieved and passes 
off. This is, of course, readily explained. The 
nostrils being blocked up, and the mouth being 
shut during sleep, the effect is the same as if 
the child were immersed in water. When the 
patient, however, is aroused, the mouth is 
opened and at once acts supplementary to the 
nostrils. 

It is a matter of great importance that you 
should put parents and nurses on their guard 
as to the position of their little patients, and 
the influence of sleep upon respiration. 

The patient before us presents, beside the 
tuberculosis, another interesting difficulty. You 
perceive that she has scarcely any power in her 
left arm ; she is unable to lift it to any height, 
and can do very little work with it. Inspecting 
the shoulder, you see at once that the muscles 
of the shoulder are much atrophied, especially 
the deltoid ; indeed, there is muscular atrophy 
of the entire arm. The whole difficulty has 
been caused by subacute rheumatism. On 
moving the head of the humerus fibrinous cre- 
pitus is felt, showing that there has been de- 
posit into the articular cavity, and that th fere is 
a certain degree of false anchylosis. From the 
muscular atrophy which destroys the symme- 
try of the shoulder, and the change of position 
of the head of the humerus from deposit in 
the joint, cases of subacute rheumatism of this 
kind have been mistaken for dislocation, and 
vice versa, and surgeons have been prosecuted 
for malpractice. It is of the utmost importance 
both for the patient and the reputation of the 
physician, that he should not confound disloca- 
tion with chronic rheumatism and its results, 
as you see them exemplified in this case. 

To return now to the more serious constitu- 
tional disease, from which the patient suffers, 
the treatment should be "building up.'^ Cod 
liver oil should be given ; it has been recom- 
mended that in cases where the digestion is 
weak, the oil should be given in an emulsion 
with an alkali, so as to render it more readily 
absorbed, and as the digestion of this patient 
appears somewhat weak, we shall combine 
each tablespoonful of oil which she takes with _ 
15 grains of the phosphate of lime. She is also 
to take iron, bark, ale, and nutritious food. 



142 



PERISCOPE. 



Vol. V. No. 6. 



To render lier expectoration more easy and 
to diminisli the dyspnoea, we shall give her 
R. Morphige acet. gr. j. 
Syrup, tolu. f ^j. 
Aqusef^ij. M. 

To be taken in teaspoonful doses occasionally. 
In prescribing cough mixtures in tubercular 
cases, never add any nauseating remedy, such 
as ipecacuanha, squills, etc.; they only dis- 
turb the digestion, which it ought to be your 
great effort in this disease to preserve. 



JEFFERSON MEDICAL COLLEGE. 

Service of Prof. Gross. 
Reported by N. G. Blalock, of N. C. 
ANEURISM OF THE AORTA. 

R. J. A. Seaman, 34 years of age, a French- 
man by birth, has been healthy during his 
youth. He has been a sailor lor twenty years, 
and the only diseases from which he had suf- 
fered were rheumatism and gonorrhoea. 

About a year ago, while undergoing great 
exertion at a pump on board the ship, he was 
seized suddenly with pain in the breast and pal- 
pitation of the heart. For this he entered the 
hospital at Java, East Indies, where he re- 
mained three months. 

Six months ago he noticed a pulsation and a 
tumor on his left side, midway between the nip- 
ple^ and the sternal portion of the clavicle, 
which has been increasing slowly till the pre- 
sent. It is more painful now than formerly, re- 
quiring the free use of anodynes to secure rest. 

On applying the ear over the tumor, the pe- 
culiar sawing or blowing sound is heard, syn- 
chronous with the contraction of the ventricles, 
and the aneurismal thrill is marked. 

There can be no doubt about the diagnosis. 
The aneurism occupies a position at the arch 
and the upper portion of the descending aorta. 
It is the result of laceration of the inner coats 
of the aorta by the over-exertion ; but un- 
doubtedly, at the time when this happened, the 
coats of the vessel were already in an unhealthy 
condition. 

As far as treatment is concerned, it is unfor- 
tunately inaccessible by any means in our 
power, either by a surgical operation or by 
pressure ; we must rely upon general and pal- 
liative remedies. Bleeding is out of the ques- 
tion ; but the heart's action may be diminished 
by the use of veratria, aconite, etc. Acetate of 
lead and opium may also be given, with a 
view to induce or promote, if possible, coagula- 
tion and obliteration of the aneurismal sac. 



EDITORBAL DEPAHTI^Ei^T. 
PERISCOPE. 

EPITHELIAL CANCER OF THE LIP. 

Mr. Jonathan Hutchinson has given us in 
recent numbers of the London Medical Times and 
Gazette interesting statistical clinical records of 
epithelial cancer of the lip. His statistical 
analysis extends over 127 cases. 

Women are the subjects of this disease in the 
proportion only of 5 to every 100 males ; and 
when it does occur in women, it is usually in 
those who have been accustomed to smoke. The 
lower lip is affected in 90 per cent, of the cases, 
the angle of the mouth in 6 per cent., and 
the upper lip in 4 per cent. The average age 
of patients suffering from cancer of the lip is 

58 years, the extremes in the series being 28 
and 82. 

Operations were performed in all the 127 
cases. Although many of them required exten- 
sive incisions, and, in three, glands were re- 
moved from under the jaw at the same time, 
only three ended fatally. One, a man aged 62, 
died on the ninth day of erysipelas of the fauces ; 
one, a man aged 54, died after an extensive ope- 
ration, " of erysipelas, attended by an eruption 
like that of scarlet fever ;" and the third, a man 

59 years of age, died from erysipelas on the 
seventh day. This rate of mortality Dr. Hutch- 
inson justly considers as scarcely worth noticing 
when we call to mind the fearful nature of the 
disease, when not interfered with. The great 
point is to attend to the general health of the 
patient and keep him removed from any risk of 
contagion from erysipelas. 

In reference to the liability to a return of the 
disease in the wound or cicatrix, in 120 cases 
out of the 127 the wound healed for the time 
being, and was reported sound when the patient 
left the hospital. The following table shows 
the results of the 127 cases. 
Died within ten days of the operation, - - 3 
Had return of cancer in the wound, - - 4 
Had return of cancer in the cicatrix at dif- 
ferent periods after the operation, - - 9 
Had cancerous disease of the lymphatic 

glands subsequently, - - _ - - 5 
Had cancerous disease of the opposite part 

of the lip, - - - - - 3 

No further note than that patients recover- 
ed and left the Hospital with sound cica- 
trices, . - - - 105* 



Dr. Rathke, Professor of Zoology at the 
University of Konigsberg, died of apoplexy on 
the evening previous to the day on which he 
was to preside at the Congress of Naturalists. 



STRYCHNIA IN THE PARALYSIS OF TYPHOID FEVER. 

Dr. N. S. Davis, of Chicago, reports the speedy 
relief of paralysis of the muscles of deglutition 
in a case of typhoid fever, by strychnia admin- 
ister ed in an enema. 

*In the above classes 3 cases are mentioned twice on account 
of their results entitling them to a place in more than one of the 
groups. 



KOVEMBER 10, 18G0. 



PEEISCOPE. 



143 



QUADRUPLE BIRTHS. 

At the October meeting of the London Ob- 
stetrical Society, Mr. Henry Gr. Times related a 
case of quadruple birth. The patient, aged 33, 
was pregnant for the fifth time. She was taken 
in labor on the morning of the 23d of Septem- 
ber, At 8 P. M. a female child was delivered 
by the midwife in attendance ; ten minutes 
after a second child, and twenty minutes after- 
wards a third, were born. 

Then followed a very large placenta, when 
the midwife, finding there was still another 
child, sent for Mr. Times. The placenta had 
drawn down the abdomen of the remaining 
child. After a little manipulation, the feet 
were drawn down, and delivery of this, the 
fourth child, efi'ected. The first three were 
alive and crying ; the last never breathed. 
There was little hemorrhage. The previous 
pregnancy terminated at eight months, in De- 
cember, 1859. The last catameniah period was 
during the first week in Margh ; but the dis- 
charge was so scanty that she conceived her- 
self then to be pregnant ; hence the quadru- 
plets were probably between six and seven 
months old. The children were all well formed 
— all upwards of twelve, and one thirteen, 
inches in length. The first lived seven hours ; 
the next two or three hours. The placenta was 
single ; but each funis had a distinct attach- 
ment. There was no lobulation of the pla- 
centa. The patient recovered well. 

During the discussion on this case. Dr. 
Bloxam stated that a case had come under his 
own observation in which all four children 
were born alive, and at the full time ; and Dr. 
Gibb mentioned that, while traveling in Ame- 
rica, he had pointed out to him four young 
ladies, 16 years of age, who, by common re- 
pute, were the product of one pregnancy. 



THE ANNOYANCES OF THE ADMINISTRATION OF 
CHOLOROFORM. 

There is continually appearing evidence of 
the loss of confidence in chloroform. The 
eminent French surgeon, Eobert, who seems to 
ignore ether, in the recent volume of his lec- 
tures, makes the following remarks in regard to 
the administration of chloroform : 

'• The first condition, for the performance with 
safety of a long and delicate operation, is that 
the surgeon should have his mind quite free. 
Now, however intelligent the assistants who 
manage the inhalation may be, still the admin- 
istration of chloroform is a great pre-occupa- 
tion for the surgeon. I confess that, for my 
part, I would rather in such a case not perform 
the operation than do it with constant fear of 
seeing some accident occur. So that you must 
reason with the patient and persuade him to 
allow the operation to be done without chloro- 
form, and exaggerate to him the dangers of 
anesthesia.'^ 



SIGHT AND REASON RESTORED TO AN INSANE PA- 
TIENT BY AN OPERATION FOR CATARACT. 

M. Bouisson, Professor at the Faculty of 
Montpelier, lately communicated to the Aca- 
demy of Medicine the case of a man, some of 
the particulars of which are given by the 

Lancet and Gaz. Hehdom. : 

He came into the hospital, without any par- 
ticulars of his previous history, suffering from 
double lenticular cataract and from complete 
dementia. Couching was resorted to for both 
eyes, and, on the tenth day after the operation, 
the man said, "I can see!'' these being the 
first sensible words he had spoken. As the 
sight improved, the man became more manage- 
able. He began to give some details as to the 
origin of his ailments ; and six weeks after the 
date of his entrance into the hospital he left, 
fully capable of earning his own livelihood. 
Prof. Bouisson adds some valuable remarks as 
to the probable connection between the restora- 
tion of sight and the return of intelligence, and 
states that he considers that sensation stimu- 
lated the mind as electricity stimulates nervous 
action, the patient being at the time favorably 
situated for such impressions. 

The dementia was probably not deeply rooted, 
and perhaps the result of optical hallucina- 
tions, in consequence of the cataract ; disappear- 
ing as soon as the cataract was removed. 



INTRA-UTERINE DISLOCATION OF THE KNEE-JOINT. 

Dr. Youmans reports in the Boston Medical and 
SurgicalJournali\\Q birth of a child, after a natu- 
ral labor, with an entire dislocation at the left 
knee-joint. The toes rested upon the anterior 
part of the thigh near the groin. The anterior 
of the knee presented the fold usual in the popli- 
teal space of infants. When the limb was for- 
cibly straightened it immediately reverted to its 
abnormal position. Straight splints were ap- 
plied and the limb is now permanently restored. 

The mother of the child attributes it to an 
injury received two weeks previously to confine- 
ment. We think that it was more probably the 
result of irregular muscular contraction depen- 
dent on defective innervation, such as produces 
congenital dislocation of the hip-joint, club-foot, 
etc. 



STRAMONIUM IN NEURALGIA. 

Dr. A. Young, in a communication to the Chi- 
cago Medical Examiner, says, that in his expe- 
rience Stramonium is an unfailing remedy in 
neuralgia. He prescribes one grain of Tilden's 
extract of stramonium leaves every two or 
three hours until the system is decidedly affected, 
as indicated by dilated pupil, disordered vision, 
vertigo, etc. It should, he thinks, always be 
given to this extent, and will seldom need repe- 
tition. 



144 



EEVIEWS AND BOOK NOTICES. 



Vol. V. No. 6. 



OPERATION FOR RADICAL CURE OF HERNIA. 

Mr. John Swift Walker reports in the Me- 
dical T'mies and Gazette a successful operation for 
hernia after Wood's operation. 

The patient being put under the influence of 
chloroform, an incision was made an inch in 
length ov^er the tumor, the scrotal fascia de- 
tached from the skin, and the fascia invaginated 
into the canal with the little finger ; a strong, 
well-curved needle, armed with a hemp ligature 
thread, doubled, was then guided through three 
points in the canal — the conjoined tendon and 
the triangular fascia forming the posterior wall 
— then withdrawing the needle, holding an end 
of the ligature in the right hand, then passing 
it again through the external pillar of the ring 
close to Poupart's ligament forming the ante- 
rior wall — the needle now only carrying one 
thread ; then placing a round boxwood plug 
over the canal, tightening the first ligature, 
with the finger pressing in the canal pressing 
up the gut ; finding it compressed the canal 
completely, tied it very tight over the plug, 
then replacing the integument put a stitch into 
the skin to close the external wound, leaving 
one loose end of thread hanging out, which 
was tied over the plug lengthways, forming 
M over the plug with the other ligatures. He 
was then placed in bed. The patient recovered 
rapidly, the wound having nearly healed on the 
eighth day after the operation ; cure perfect. 



THE ALLEGED DISCOVERY THAT THE SEX OF A CHILD 
MAY BE ASCERTAINED BY COUNTING THE PULSA- 
TIONS OF THE FCETAL HEART. 

The assertions of Dr. Frankenhauser in 
regard to a method of determining sex be- 
fore birth of the child have been brought 
to the test by several observers. Frankenhauser 
examined one hundred pregnant women, and 
says that he found the less rapid pulsations of 
the foetal heart in those who gave birth to boys 
and the more frequent when girls were after- 
wards born. The first gave a mean of 124 beats ; 
the latter 144 to the minute. 

Dr. Breslau made fifty observations on the 
subject, and the result was that twenty-five 
times he made a false prophesy, and nineteen 
times a right one, leaving six doubtful. 

Dr. Hoake made observations on fifty women, 
but without finding the rule of any value in 
foretelling the sex of the child. 



A Coroner's Verdict! — At, Bristol (England) a 
man had eaten largely, chiefly of meat, and, 
being subsequently taken ill, was found dead in 
his bed early the next morning. No medical 
man had visited him, nor had he taken any 
medicine. The jury, after hearing the evidence, 
returned a verdict that " the deceased died sud- 
denly after eating to excess of food imjprojperly 
dressed !" 



REVIEWS AND BOOK NOTICES. 

On the Theory and Practice of Midwifery. — 

By Fleetwood Churchhill, M. D., etc. 

With additions by D. Francis Condie, M. 

D., etc. a new American from the Fourth 

Corrected and Enlarged English Edition. 

Philadelphia : Blanchard & Lea, 1860. 

The present volume, although its predeces- 
sors have been repeatedly noticed, demands 
particular mention, because it is not a mere 
reprint, but, what it purports to be, an improved 
and corrected edition, containing fully one-half 
more matter than when last reprinted. In a 
hasty glance over the various chapters we find 
that the one treating of menstruation is more 
fully elaborated than in previous editions, and 
the interesting questions of the connection be- 
tween menstruation and ovulation are fairly 
discussed, though the author avoids taking a 
decided stand in favor of one theory or the 
other. We are glad in this chapter to find 
another evidence that the labors of American 
investigators are gradually beginning to be ap- 
preciated abroad, as the copious extracts from 
Prof. Dalton's writings show. 

In the chapter on sudden death during labor, 
very interesting cases are mentioned, illustrat- 
ing typically the various causes of sudden 
death, — syncope, idiopathic asphyxia, nervous 
shock, absorption of air by the uterine sinuses, 
the formation of a fibrinous coagulum in the 
heart, disease of the heart, obstruction and 
rupture of the pulmonary arteries, etc. 

In reference to the entrance of air into the 
blood through the uterine sinuses, though seve- 
ral cases are referred to in the work, none ap- 
pears so clear as that of Dr. Swinburne, of 
Albany, published about a year ago in the 
Eeporter. 

It will be remembered that some months ago 
a paper on pulmonary apoplexy as a cause of 
sudden death in labor, read by Prof. Gardner 
before the N. Y. Academy of Medicine, and 
published in full in this Journal, gave rise to a 
discussion in that Society, during which it was 
evident that the members of the Academy were 
disinclined to favor the theory. We have read 
the full chapter on sudden death in the work 
before us, with care, but failed to find a case 
analogous to the one of Dr. Gardner, in which, 
unfortunately, a postmortem examination could 
not be obtained. It is evident, however, that 
this subject is not yet fully understood, and that 
a great deal remains to be done by future in- 
vestigations. 

Turning to the subject of puerperal peritoni- 
tis, we were much astonished that so little at- 
tention is paid to the important matter of the 
treatment of this disease. The history of the 
disease, its epidemic and contagious nature are 



November 10, 1860. 



EDITORIAL. 



145 



fully and admirably treated, wliile the author, 
after citing the authorities who respectively de- 
fend the claims of venesection, tartar emetic, 
purgatives, emetics, turpentine, hip-baths, etc., 
concludes as follows : 

" A selection of these remedies will afford a 
tolerably good chance to the patient, if we are 
called early; but in many instances we shall 
fail, either in cutting short the disease or in 
curing it ultimately. It is of the greatest im- 
portance, however, that all the means at our 
command should be tried perseveringly, and 
that our forebodings should not be allowed to 
diminish our exertions." 

We know very well that experience has 
shown the inefficiency in severe cases of all 
these plans of treatment, and we do not blame 
the author for taking no decided stand in favor 
of one kind of medication or the other, as there 
can be no specific, and various cases demand 
various treatment. Yet it can scarcely be con- 
sidered an excusable oversight on the part of 
the author or editor, when the treatment by 
opium and veratrum viride is entirely ignored. 
There is at this time quite a sufficient number 
of well-authenticated cases on record by autho- 
rities of the highest standing, and they were un- 
doubtedly accessible to the author or editor of 
the work. Whateter individual opinions may 
be, this much is certain, that both the opium 
treatment of puerperal fever, as first introduced 
by Prof. Clark, of New York, and the treat- 
ment by veratrum viride, which originated, if we 
mistake not, with Prof. Barker, have yielded 
more favorable results, — at least as favorable — 
tlian any other mode of treatment, and an en- 
tire ignoring of both, renders this part of the 
work incomplete, especially so, as throughout 
the whole book we find a fair and complete 
resume of different modes of treatment, theo- 
ries or opinions. We must express our sincere 
desire that this deficiency will be supplied in the 
next edition. 

The work contains an appendix of two chap- 
ters, which have not appeared in the previous 
editions; — one on "obstetric morality;" the 
other on the qualifications and duties of the 
monthly nurse. The former is a reprint from the 
Dublin Quarterly Journal, and is devoted to 
the questions of baptism, craniotomy, and the 
Ceesarean section as they have from time to 
time been the subjects of medico-religious con- 
troversy. The chapter on nurses is a reprint 
from the " Manual for Midwives and Nurses," 
recently published by Dr. Churchill, and is an 
v^excellent practical little treatise. 


The eloquent discussions of the French Academy 
of Medicine are not very highly appreciated by 
M. Champoullion, who pronounces them as 
delightful to amateurs of fine speeches, but as giv- 
ing no practical instruction. The physician 
who has no fancy for this kind of literature, 
considers chefs d'ceuvre of eloquence simply as 
crystals grouped around a dead piece of wood. 



THE MEDICAL AND SURGICAL REPORTER. 



PHILADELPHIA, SATURDAY, NOVEMBER 10, 1860. 



ORGANIZATION. 

Present medical organization in the United 
States is, to use an illustration, like a man 
whose limbs are paralyzed. His intellect is all 
clear, his perception acute, his sensation per- 
fect, his speech complete, but when the time 
comes for action, when he is to repulse an 
enemy, when he is to attack a foe, or when he 
is to march on in the path of progress, the pal- 
sied limbs are powerless ; they do not follow 
his intellect and his will. 

But have we not our American Medical As- 
sociation ? Our State, our County Societies ? 
Certainly ! But so has the paralyzed man his 
brain, his senses, and his will. 

The great point in all organization is the in- 
timate connection and harmonious operation 
between periphery and centre. The same law 
of organization and development, of growth 
and decay, which characterizes the mollusc, is 
in operation in the social organism of mankind, 
and he who has most closely studied the for- 
mer will be best enabled to appreciate the 
tendencies of the latter. 

Now, it is a law of physiology, that the ca- 
pillaries are developed before the arteries, veine, 
and heart; that the peripheral nerves and 
nerve ganglia exist before the brain or spinal 
marrow ; and that upon the normal and ener- 
getic development of the former depend the 
future growth and development of the latter. 
Before the town and city exist, there are vil- 
lages, hamlets, and farms; and before republica 
are formed we must have republican sentiment 
instilled into the masses. Development — phy- 
siological, social, and moral — is always from the 
periphery to the centre, the opposite being an 
anomaly. 

There is no class of men more conversant 
with these fundamental principles of organiza- 
tion than physicians, the students of nature, 
and cultivators of natural &c\z-x\q,^, pax excellmce. 
And yet why is it that so little has yet b€«n 
done to make medical organization throughout 
the United States what it should be ? 



146 



EDITORIAL. 



Vol.- V. No. 6. 



Is it because there is no necessity for organi- 
zation? We need simply look at the great 
ends to be accomplished in providing for proper 
sanitary legislation and government through- 
out the States, and which will never be attained, 
except by the influence of the medical profes- 
sion, to convince us that organization — perfect, 
active, worJcing organization — is imperatively de- 
manded. We need but consider the evils and 
crimes that are rampant in all the forms of 
quackery to stimulate us to organization ; and 
we need only view the advance, progress, and 
reform necessary in medical education to satisfy 
the most skeptical that the only means to raise 
the status of the profession is by determined, 
deliberate, organized action. 

But, aside from this view of the subject, me- 
dical societies form in many parts of the 
country the only scientific stimulus and im- 
pulse to the practitioner. In this light alone 
organization is a necessity. 

There is not a town or city, of five thousand 
inhabitants, in the United States, in which there 
ought not to be a medical society, well orga- 
nized, meeting at least once a month, and in_ 
eluding every respectable practitioner of the 
surrounding country. It is unnecessary to re- 
peat the old anecdote of the bundle of sticks to 
prove that in union and organization alone is 
strength. There are social, ethical, and scien- 
tific interests which our profession has, that 
can be promoted only by organized action. 

Let, then, our friends go to work during this 
winter, revive old societies, form new ones, 
where none exist, so that the American Medi- 
cal Association, as the centre of the profession 
in the United States, will be stimulated by an 
active capillary circulation, and at its next ses- 
sion show a glorious medical revival. 



TIMELY RESOLUTIONS. 
The profession is everywhere waking up. An 
earnest determination is making itself felt 
throughout the country of opposing the grow- 
ing evils of the day, of uttering the warning 
voice against crimes, by which the health of the 
nation is undermined, its morals defiled, and 
the lives of the people trifled with. The fol- 



lowing timely resolutions were unanimously i 
adopted at a late meeting of the Scott County | 
(Iowa) Medical Society, on motion of Dr. 
Fountain, and ordered to be published in the 
papers : 

Whereas, The medical profession are every- j 
where cognizant of the fact that the crime of 
criminal abortion is fearfully prevalent, and in- 
creasing in all classes of society ; and 

Whereas, The progress of civilization and the 
spread of religion appear not to have had the 
effect of diminishing this species of iniquity ; 
therefore, be it 

Besolved, 1. That themembersof this Society 
will co-operate with the American Medical 
Association, and other organizations of the 
kind, in using every effort to disseminate a 
knowledge of the criminal nature of practices 
which are too often regarded as harmless, and 
frequently resorted to by many who would 
shudder at the thought of destroying the life of 
a human being. 

2. Resolved, That the members of this Society 
unite in sentiment with the opinion of the best 
and most learned men of the profession, in all 
parts of the world, that the fcEtus is a living being 
from the earliest period of gestation, the will- 
ful destruction of which, except when required 
for the preservation of the life of the mother, is 
a crime as monstrous as infanticide, and its 
perpetrators should be regarded as felons by the 
laws of man, as they must be by every precept 
of morality. 

3. Resolved, That every member of this So- 
ciety who may be known to yield to the solici- 
tation of any party for the purposes above indi- 
cated, shall forfeit his membership and be 
regarded as unworthy of fellowship by all 
honorable physicians. 

4. Resolved, That it shall be considered the 
duty of every physician, when application for 
such purpose is made, not only to decline 
promptly, but to exert his personal influence to 
the utmost to prevent its accomplishment, by 
explaining its criminal character and removing 
as far as possible the erroneous opinions which 
are so generally prevalent regarding the life of 
the foetus. 

5. Resolved, That we denounce the common 
practice of newspaper proprietors in publishing 
advertisements which are calculated to en- 
courage the practice of criminal abortion, as 
one prolific cause of a vast amount of crime 
and immorality, for which such newspaper 
editors and proprietors are thereby in a great 
degree responsible. ' 

6. Resolved, That we likewise denounce the 
practice of many druggists in keeping for sale 
and dispensing such preparations as are known 
to be used for the purpose of producing abor- 
tion, which practice is no less reprehensible 
than to furnish poison when knowingly pur- 
chased with murderous intent, and by which all 



November 10, I860.] 



EDITORIAL. 



147 



such druggists Sire participes criminis in the evil i dead relations of poor men when he was Gover 
work of corrupting good morals, and willfully ^^^ nf tViP AlTYisTinnsp 



engaged in aiding and assisting in the perpe^ 
tration of a crime which should be held in ab- 
horrence by every member of a civilized and 
Christian community. 



MEAN POLITICS. 
A more foolish and meaner political trick has 
never come to our knowledge than that re- 
sorted to in New York against a candidate, who 
formerly was one of the governors of the Alms- 
house. This gentleman issued the following 
order : 

"New York, Feb. 3, 1860. 
"T. Daily, Esq., Warden of Bellevue Hospital : 
"Sir : — In order to allow facilities for instruc- 
tion, you will permit a post mortem examina- 
tion on all bodies, claimed or unclaimed, if such 
are deemed necessary by the Visiting Surgeons 
or Physicians, and under their direction and 
supervision the Medical House Staff and Medi- 
cal Students are allowed to make such exami- 
nation. '' 

We omit the gentleman's name and the party 
to which he belongs. Neither have anything to 
do with the principle involved. But listen to the 
following indignant outbursts of political 
"shoulder hitters:" 

" Read, read, read ! Let all who have human 
feelings read and remember these facts ! 

"About the first of last February an attempt 
was made by certain surgeons of this city to 
obtain from our charitable institutions a supply 
of dead bodies, to be used in anatomical experi- 
ments and lectures. This purpose, revolting to 
Christianity and naturally repugnant to every 
gentle feeling of human nature, was virtually 
assisted in its accomplishment through an order 
signed by * "^ * one of the governors of 
the Almshouse, in connection with two of his 
associate governors. '^ '"' * and his friends, are 
challenged to deny the truth of these charges. 
The order stands open to public inspection on 
the Records of Bellevue Hospital, where all 
who might be otherwise led to doubt that such 
atrocities were possible, can satisfy themselves 
of its authenticity. 

"This order went into effect, and what were 
its results it would be almost impossible to de- 
scribe. The simple fact that authority was 
given to dismember and scatter in unconsecrated 
earth the bodies of the dead poor of this city is 
a melancholy exhibition of the claims of a can- 
didate now before the people for their support 
to elect him to a responsible office. 

" Poor men of New York, * ^ is appealing 
for your suffrages, on the ground of being a 
friend to your interests. Read the above order, 
and decide how much sympathy he had for the 



nor of the Almshouse. 

" Christians of New York, who are opposed to 
violating the sanctity of the dead, * * is a 
candidate for Register. Is the man who would 
give your bodies over to the dissecting room 
entitled to your suffrages ?" 

Such are the appeals of miserable dema- 
gogues, who in the name of humanity and 
even Christianity (!) excite the prejudices of the 
ignorant masses, when attempts are made to 
further the cause of science, which is that of 
true humanity. 



MORTALITY OF CITIES. 

We shall condense, every month, a summary 
containing some of the most important facts of 
our weekly mortality tables. For the four weeks 
ending September 22 and 29, and October 6 and 
13, 1860, we have the following : — 

Total deaths, 

Males, . 

Females, 

United States, 

Foreign, 

Nativity unknown. 

We have not yet been able to obtain the offi- 
cial reports of the population, and prefer to 
wait for correct figures to estimate the per cent- 
age of mortality to the whole population. 

In reference to the causes of death, the fol- 
lowing is a summary of the most important 
zymotic diseases, including consumption and 
marasmus : — 



Philadelphia. 


New Tork. 


851 


1,700 


358 


657 


305 


621 


650 


1,121 


158 


564 


n, . 43 


15 





i 


'S . 


•H 


o 


Causes of Death, 


•3 


If 


^ 
1 


s"^ 




S 


^ 


;zi 


s 


Croup, - - - 


22 


2 1-2 


24 


1 2-5 


Cholera rnfantum, - 


19 


2 1-4 


94 


5 1-2 


Diphtheria, 


31 


3 2-3 


24 


1 2-5 


Dysentery, 


15 


1 3-4 


33 


2 


Fever— Typhoid, 


16 


1 9-10 


22 


1 3-10 


" Typhus, 


6 


7-10 


42 


2 1-2 


" Scarlet, 


71 


8-3 


73 


4 3-10 


Whooping Cough, 


4 


1-2 


19 


1 1-8 


Small Pox, 


5 


6-10 


18 


1 1-16 


Consumption, - 


119 


14 


269 


15 9-10 


Marasmus, 


51 


6 


171 


10 1-12 



It will be seen that in Philadelphia 20 per 
per cent., and in New York nearly 26 per cent., 
of the whole number of deaths are caused by 
consumption and marasmus — the two most fre- 
quent and fatal tuberculous diseases. The deaths 
from scarlatina and diphtheria are, in Philadel- 



148 



CORRESPONDENCE. 



Vol. V. No. 6. 



phia, 12 per cent. — ^in New York 5 per cent. — 
showing a prevalence of these diseases in Phila- 
delphia over New York. 

Typhus fever, on the contrary, owing to the 
emigrant ships in New York, constitutes 2J per 
cent, of the whole in that city ; while in Phila- 
delphia it is but 7-10 per cent. 

In reference to age, the per centages are as 
follows : — 



Ages. 



Under 5 years, 

5 to 10 " 

10 to 20 " 

20 to 50 " 

50, and over, 

Unknown, 



Philadelphia. 


iVei 


I| 

407 


"3 

1 


822 


47 8-10 


59 


7 


66 


4i 


5 1-6 


67 


207 


24 1-3 


511 


134 


15 3-4 


221 
13 


851 




1700 



48 1-2 
3 9-10 
3 19-20 
30 3-29 
13 
8-10 



It will be seen that the per centage of infan- 
tile mortality, including all under five years, is 
nearlythe same in both cities, and, as an index of 
the general state of health, (which we consider 
infant mortality to be,) would place both cities 
on a par. 

But it must be remembered that in the Phila- 
delphia reports the still-horn are included, while 
in New York they are left out, as we understand, 
to make the sanitary misgovernment of that 
city less apparent. Now, in Philadelphia, the 
number of still-born in the whole number of 
851 is 47 or 5 J per cent. According to the same 
ratio, the number of still-born in New York 
ought to be 94, which, added to deaths under 
five years, will yield a per centage of 51 per 
cent., or over 3 per cent, more than Philadel- 
phia. There is, however, reason to believe that 
the ratio of still-born in New York is larger than 
in Philadelphia, which would make the per cent- 
age of infant mortality still greater. 

We are sorry that the reports from New Or- 
leans have hitherto not reached us in time to 
be published with the rest ; arrangements, how- 
ever, are now made soon to remedy the defi- 
ciency. In regard to the health of New Or- 
leans, a correspondent writes us as follows : — 

'^ We have had almost an epidemic of " bil- 
ious remittent,'^ (miscalled Jamaica negro, 
" Dandy •/' Spanish corruption, " Denka'' and 
" Danka ;" French spelled, " Dengue,'') which 
for a time misled a few of our physicians into 
the admission that it was yellow fever, and 



quite a panic was excited among persons at a 
distance. But the real truth — now admitted 
by all respectable men in the profession — is, 
that there has not been one unequivocal case of 
yellow fever in New Orleans, whether in the 
Charity Hospital or in private practice, during 
the past twelve months. The health now ia 
extraordinarily good.'' 



CorrtspnientK 



■-, IlUnois, Oct. 30iA. 



Editors of Medical and Surgical Reporter : 

Herewith I send you a late number of an 
Oregon paper, with some articles marked for 
your perusal. I wish to call your attention to 
them in connection with your editorial in Ri^- 
PORTER for 20th inst., on Revoking Diplomas. 
It is time for medical schools to scan well the 
characters of the men to whom they grant these 
honors. No physician would be deceived as to 
the meaning of Doctor Rand's letter, but it ia 
rather ambiguous to the popular mind, and, as 
you see, has been made use of by the quack to 
bolster himself up. It is said "that medical 
schools sometimes grant diplomas for a con- 
sideration." That schools of established repu- 
tation do so I cannot believe, but think perhaps 
it may be done by others. If done by any, a 
direct injury is done to the cause of medicine, 
and tends to bring reproach on all. Certain it 
is, that the mere fact of a man's having a di- 
ploma is no sure criterion either of his skill or 
his character. It is to be hoped that the Am. 
Med. Association will take this whole question 
into careful consideration, and establish some 
system of granting its own diplomas to those 
worthy to hold them. No honorable and trust- 
worthy physician will shrink from the ordeal. 

Medicus. 

P. S. I am aware of some notorious quacks 
in this State who claim to hold diplomas from 
medical schools. I shall try and get the facta 
in their cases, and will report them to you. 

[We have perused the papers referred to, and 
find that they constitute a glaring case of 
quackery. The individual in question is one 
" Dr." L. J. Czapkay, who advertises his Medi- 
cal and Surgical Institute in the following 
strain : 

" In the schools of France, the highest prizes 
are often awarded to practitioners in this de- 
partment of medical science, and they occupy 
with others an equally lofty position in the pro- 
fession. Ricord is an illustrious example, a 
shining light among the philosophical stare of 
his age in Europe, and Dr. Czapkay has fully 
equalled him in this country, as a proof of 
which, the Philadelphia College of Medicine 



NOTEMBER 10, 1860. 



CORKESPONDENCE. 



149 



complimented him witli a diploma, and the 
honorary ad eundem degree. Selecting this as 
his field of operation, although qualified as a 
graduate of the University of Pesth, and late 
Chief Surgeon of the Hungarian Revolutionary 
army, for more extended labors, Dr. L. J. 
Czapkay has bent his earnest attention to the 
cure of chronic .and private diseases, in which 
he has become so great an expert that he is now 
regarded as the leader in this branch of his 
profession throughout the United States, and 
his portrait and biography are published as 
matter of interest to their readers in the most 
exclusive journals.'^ 

Through false representations, undoubtedly, 
this individual obtained the ad eundem degree 
from the Philadelphia College of Medicine. 
The letter of Prof. Rand, referred to by our 
correspondent, is intended to counteract this, 
and for this all credit is due. 

Yet this Czapkay has the impudence to pub- 
lish Dr. Rand's letter as evidence of having 
received an honorary degree, and no doubt the 
public will look upon Dr. Rand's letter as in 
his favor. 

We maintain that the only remedy for simi- 
lar occurrences and their prevention is, that 
such diplomas be formally and unequivocally 
revoked, and unless they are, that schools 
whence they emanate be refused representation 
in the American Medical Association. The 
interests of the profession are paraynount, and it 
is time that they be maintained. — Edit.] 



CURIOUS CASE OF INTERMITTENT SPASMS, WITH 

ALBUMINURIA GOOD EFFCTS OF QUININE AND 

OPIUM. 

To the Editors of the 

Medical and Surgical Reporter : 

A rather unique case recently occurred in 
my practice which it may be of interest to com- 
municate. We seldom meet with symptoms of 
so grave a character yielding so happily to me- 
dication as those in this case. We have here, 
apparently, two distinct diseases : — Bright's dis- 
ease and chronic inflammation of the spinal 
meninges, both of which are, in the course of a 
month, seemingly cured by the use of quinia 
and opium. Claude Bernard's theory, that 
most, if not all, forms of disease depend on the 
irritation of the nerves, is certainly not in- 
jured by the facts in this case. 

In June last, E. H., a farmer, 26 years of 

age, and married, sent for me. He said he had 

been sick for nine weeks, and most of the time 

confined to his bed : that he was daily grow- 

12 



ing worse, and would, without relief, soon die. 
He was first taken with clonic spasms of the 
bowels, which, however, were soon transferred 
to his limbs, in which they had continued for 
over two months, although every thing had 
been done by his physicians for his relief which 
their ingenuity could suggest. At times the 
spasms became universal, amounting almost to 
convulsions. He attributed his disease to ex- 
posure while burning lime. 

Although his digestion was apparently unim- 
paired, he was much emaciated. Aspect waxy- 
looking ; surface dry, pale, and almost blood- 
less ; had many boils, especially upon his 
limbs ; complained incessantly of severe and 
acute pain in his loins, extending downwards 
to the remotest part of his extremities, which, 
though oedematous, were very thin and wasted. 
He retained in them the power of voluntary 
motion. The urine was less than the ordinary 
healthy average, diminished in density and 
highly albuminous. 

I ordered solution of morphine in doses sufii- 
cient to render him, in a manner, comfortable, 
and to be repeated as occasion should require ; 
also bitartrate of potassa, to be given freely as 
a diuretic ; fluid extract of rhubarb, to regulate 
the bowels, which did not move without medi- 
cine ; tincture ferri chloridi and quinia every 
eight hours, and a nutritious diet. Under this 
course of treatment for a week, his symptoms 
evidently improved, when suddenly he was 
seized with the universal clonic spasms be- 
fore alluded to, requringthe strength of several 
men to control and prevent him from seriously 
injuring himself. Upon closer inquiry, I learned 
that these frightful paroxysms were usually pre- 
ceded by the ordinary preliminary symptoms of 
fever, such as feelings of languor, general un- 
easiness, stretching, yawnmg, etc., and also 
by a sensation of chilliness, particularly in the 
feet and limbs, and that they had come upon him 
about the close of each week for several weeks. 
I therefore determined to try the power of 
quinia in arresting their recurrence. It being 
Saturday, I made no alteration in the treat- 
ment till the next Thursday, when I com- 
menced the use of the antiperiodic, in connec- 
tion with morphia, as before employed. Con- 
tinued these medicines until the Monday follow- 
ing, with the satisfaction of completely pevent- 
ing a return of the paroxysms, which had so 
long bafiied former treatment. From this time, 
under ferruginous, tonic and anodyne medicines, 
in conjunction with a generous diet, the patient 
was rapidly restored to health and strength. 

Jos. S. Cook. 
Washington, Warren county, N, J"., 
Nov, 5, 1860. 



150 



CORRESPONDENCE. 



Vol. V. No. 6. 



PARISIAN CORRESPONDENCE. 
Tlie Academie des Sciences — M. Gratiolet's Researches on the 

Vascular System of the Hippopotamus — Erroneous Views — 

Death by Immersion. 

Paris, Oct. 13, 1860. 
I promised you to commence my correspond- 
ence with the Reporter at once upon my ar- 
rival here. But a month has passed so rapidly 
between sight-seeing, getting "initiated'^ into 
medical circles, and making acquaintances that 
I was considerably vexed when I received a 
bundle of Reporters yesterday, which reminded 
me of my negligent silence. Not that I have 
any idea of considering my jottings of any 
value, but because I like to adhere to my pro- 
mises. 

It is needless for me to say, — for all your 
readers have been informed of the fact again 
and again in the newspapers, — that the exte- 
rior of Paris, or what we might call in patho- 
logical parlance, its decubitus, complexion, and 
physiognomy, have entirely changed since I was 
here last, ten years ago. Streets have been 
widened, whole blocks and squares have been 
torn down to make room for public places ; by 
the indirect interference of the government, more 
commodious and healthy " quariiers " have been 
built for the working classes. Indeed, what- 
ever opinions we may entertain as to the politi- 
cal honesty of Napoleon the Third, credit is 
due him for the care which his government 
bestows upon the social and sanitary condition 
of his '^ Parisiens." 

Academy of Sciences. — On the first of this 
month (which, if you will look at your almanac, 
was on a Sunday) I attended the Academy of 
Sciences, M. Charles presiding. You are, of 
course, aware that, in France as well as in Ger- 
many, it is not at all uncommon to have meet- 
ings, scientific and otherwise, on the first day in 
the week, which our Anglo-Saxon notions would 
consider a grievous error, to say the least. 
However, the meeting was an interesting one. 

Researches on the Circulation of the Hippo- 
potamus. — M. Grratiolet communicated his re- 
searches on the vascular system of the hippo- 
potamus, in which he gives a perfect explana- 
tion of the anatomical and physiological me- 
chanism by which this animal is enabled to 
keep under water the great length of time which 
it does. 

The stylo-hyoideal and digastricus muscles 
of the hippopotamus, in consequence of a pe- 
culiar conformation of the basilar portion of 
the OS hyoides, instead of leaving a free passage 
for the external carotid artery, cover and sur- 
round this vessel directly at its root ; hence the 
least contraction of these muscles compresses the 
external carotid more or less, and the result is 
a corresponding arrest or diminution of the flow 
of blood to the head. This anatomical arrange- 
ment appears to prevent cerebral congestion 



during the long stoppages of respiration, which 
are common to this animal. A similar arrange- 
ment is found in the venous system. In the 
coats of the inferior vena cava, a muscular 
ring, or kind of sphincter, is found, which, 
when contracting, prevents the blood of the vena 
cava from reaching the heart, causing the blood 
to accumulate in the smaller venous branches ; 
the blood of the superior cava, however, flows 
freely into the right auricle, whence it passes 
into the lungs, and so on through the arterial 
system. 

Erroneous Views — Death from Immersion. — 
These anatomical arrangements M. Grratiolet 
considers as tending chiefly to prevent conges- 
tion of the nervous centres when the animal is 
immersed, which he looks upon as the princi- 
pal cause of death. 

It seems to me, however, that in his explana- 
tion of the manner in which these anatomical 
peculiarities act, in enabling the animal to sus- 
tain long immersion. Monsieur Grratiolet is mis- 
taken. 

For, in the first place, it is not very probable 
that in animals of the lower classes simple con- 
gestion of the brain should play so important a 
part as to demand special muscular arrange- 
ments to prevent it. But, secondly, and chiefly, 
it has been shown by the conjoined experiments 
of Dalton, of New York, and Da Costa, of Phi- 
ladelphia,^ that in death from sufl'ocation, or 
stoppage of the respiration, the heart becomes 
paralyzed from over distension of its muscular 
fibres because of the arrested capillary circula- 
tion ; which is arrested, not so much on ac- 
count of mechanical congestion in the smaller 
vessels, but in consequence of the blood being 
surcharged so much with carbonic acid that the 
peculiar attraction of the tissues to the blood in 
their capilliaries, which is the chief condition ot 
active capillary circulation, is lost. 

Now it seems to me that, rather than pre- 
venting death by preventing congestion of the 
brain, this peculiar anatomical arrangement in 
the circulation of the hippopotamus, prevents 
death, during immersion, by preventing the 
over-distension of the heart, which would other- 
wise lead to paralysis of its muscular fibres. 
The current of the vena cava to the heart being 
partially, or completely, shut ofl" by means of 
its sphincter, it is plain thsit the amount of blood 
which presses to pass through the heart and the 
arterial system is greatly diminished. Again, 
the external carotid being compressed, a less 
quantity of blood is sent through the arterial 
system than when the animal is not under 
water. Both these circumstances directly tend 
to diminish the liability of the blood to become 
surcharged with carbonic acid, which would re- 
sult in stagnation of the blood, over-tension and 
paralysis of the cardiac fibres. In other words, 
death, from stoppage of the respiration, being 



* I have not the lectures of the former gentleman with me and 
hence cannot quote very precisely. 



November 10, 1860. 



NEWS AND MISCELLANY. 



151 



due to paralysis of the heart from over-disten- 

■ sion, the anatomical peculiarities of the hippo- 
potamus, already mentioned, have the object 
mechanically and chemically to counteract that 
over-distension and paralysis, and not, as M. 

j Grratiolet supposes, to prevent congestion of the 
' nervous centres. 

; The Laryngoscope. — Are your Philadelphia 

! and New York surgeons armed with their laryn- 

; goscopes ? Dr. Czermack has spent some time 

here advancing the claims of his invention, and 

although some of the faculty are not at all dis- 

■ posed to look with favor upon le Professeur 
Autrkhien, yet they cannot help giving credit 
where it t3elongs. Czermack has made many 

''' warm friends and admirers while here ; among 
these is Mourat Bourouillon, who at a recent 
meeting of the Academy communicated two 

' interesting cases of aphonia, the pathological 

' course of which was unequivocally demonstra- 
ted by examination of the glottis by means of 
the laryngoscope. 

In one of the cases there was a growth, in 
the other a polypus hanging or inserted in or 
around the vocal chords, and other lesions 

' existing much more frequently in cases of apho- 
nia, it is said, than were formerly thought. 
M. Bourouillon has proposed to destroy the 

' morbid growth by the galvanic cautery. This 
seems harsh treatment ; but a Frenchman cares 
nothing about that, as long as novelty is on 

' his side. 

Yours, Jatros. 



excellent institutions for instruction with one 
of the best corps of clinical teachers, deserted. 

It is hoped the matter will be taken in hand 
at once. 



NEWS AND MISCELLANY. 

Clinical Instruction at the Pennsylvania and Phi- 
ladelphia Hospitals. — The effect of ^he free ad- 
mission of students to the Philadelphia Hospital 
begins to show itself. On Wednesday last, over 
four hundred students availed themselves of its 
opportunities ; while at the Pennsylvania Hos- 
pital, where tickets were for the first time de- 
manded for this season, the class was not over 
thirty. 

We earnestly hope the managers of this ex- 
cellent and time-honored institution will at 
once see the necessity of throwing open its 
gates for clinical instruction, free. The profes- 
sion, who for nearly a century, have given their 
gratuitous labors to the hospital, rendering it 
what it is, have a right to demand that what- 
ever benefits may accrue from it to science 
should be free. 

The institution is sufficiently well endowed 
not to need the paltry few hundred dollars a year 
from the pockets of the student. Unless thrown 
open, as all the hospitals in our larger cities 
now are, to the student, free of charge, we shall 
have the mortification of seeing one of the most 



The Disinfection of Sewage. — The Lancet says 
that. in the town of Carlisle, (England,) a public 
effort is being made to demonstrate that the sew- 
age of great towns may be effectually and inex- 
pensively disinfected. A contractor has obtained 
lease of the sewage of Carlisle, and of a hundred 
acres of land close to the town. He now disin- 
fects the sewage as it issues from the town with 
a carbolic acid solution, and then leads it over 
the land. Dr. Angus Smith gives a full account 
of the present results of the experiment, which he 
speaks of as being perfectly successful. He says 
the land can be seen by any one passing out of 
Carlisle by the Caledonian Eailway to the north. 
The crops of grass are very rich upon it ; but at 
present so many sheep and cattle graze on it 
that it is kept somewhat bare. The result is, 
that the sewage flows over the land, and no one 
on walking over the ground can tell that the 
moisture in it is other than the rain. There is 
no long canal running to the sea, costing a great 
deal of money wherever it goes ; neither is there 
a beautiful river tainted by sewage, becoming 
loathsome to all the senses, and a grave to the 
fishes that have so long frequented it, to the 
profit and pleasure of the inhabitants. Sew- 
age may now cease to be an evil as it issues 
from towns. It need not be dreaded by any of 
the proprietors of land, neither need it be dreaded 
by manufacturers on the streams, if there be 
convenient land as at Carlisle ; and, in any case, 
putrefaction or pollution of the air may be made 
to cease. The whole of the Carlisle sewage is 
thus absorbed. The average amount is 666,116 
gallons. The sewage is led on the land by 
trenches merely. The whole cost of the estab- 
lishment was under £400. The cost of the ma- 
terial for disinfecting the sewage of Carlisle is 
55. M. per day, or £95 — or less than $500 — per 
annum. Dr. Angus Smith concludes, from the 
results of this experiment, that a great problem 
is solved. He considers that it is shown that 
sewage may be made to be entirely inoffensive 
to the most delicate senses — that it may be even 
made to disappear, and not pollute the rivers ; 
and this effect may be produced in such a way 
as not only to incur no expense, but to be 
rather a source of at least some profit, although 
the exact amount cannot yet be estimated. The 
plan has only been in operation at Carlisle dur- 
ing this season. The estimated increase of pro- 
duce is more than double. 

The same agent, carbonic acid solution, was 
tried successfully in London last summer by 
Dr. Letheby. 



Dr. Wynter has resigned the editorship of the 
British Medical Journal, an excellent weekly pub- 
lished in London. 



152 



NEWS AND MISCELLANY. 



Vol. V. No. 6. 



The Pauper Insane of Englo.nd. — At the return 
issued by the Poor-Law Board on the first of 
January last, the number of paupers in re- 
ceipt of relief in England and Wales was 850,890. 
Of these, 31,543 were insane, including 9,165 
idiots — constituting 3.71 per cent., or no less 
than one in every 27 paupers. Of course this 
estimate gives no indication of the proportion 
of insane to the general population. The re- 
turn indicates that the number of idiots pre- 
dominate in rural mountainous districts, as in 
Wales, while in the large cities, as London, 
Manchester, &c., the insane predominate. The 
return also shows that there are more women 
insane than men — 17,647 to 13,896. The ex- 
pense of maintaining these 31,543 pauper in- 
sane is stated to be nearly £10,000 a week, or 
£520,000 a year, or, in our currency, $1.58 a 
week, or $82.16 a year for each patient. Over 
half the above patients were lodged in hospitals 
for the insane. Of the remainder, half were in 
work-houses, 5,195 resided with relatives, and a 
few in licensed houses or in lodgings. 

^Stung to Death. — The following case is related 
in the journals: 

A young farmer, named Jay, of St. Cryan, 
near Meaux, went into a wood to collect leaves 
of a nut tree for his oxen. He began beating 
down the leaves with a long stick, and before 
long was enveloped in a cloud of dust, which 
produced such a violent cough that he was 
obliged to return home. His face, hands, and 
neck, soon became covered with pimples, he 
had a violent fever, and insupportable itching. 
He tried various remedies, but they produced 
no effect, and he was at last obliged to send for a 
physician. The latter did all that science could 
suggest, but in a few hours the patient expired. 
It turned out that the farmer had disturbed a 
nest of the insect called, by French naturalists, 
the Bombyx processionnaire, which is very venom- 
ous, and which places its eggs in the 'midst of 
a sort of dust. This dust, which is very volatile, 
causes ulcerations in the skin of man, and is 
most dangerous when it enters the respiratory 
organs. 



Hospital Statistics. — A measure of great practi- 
cal importance and interest has been ordered 
by the Director of Public Charities in Paris. 
The object is to collect reliable and perfect sta- 
tistical records of all Parisian Hospitals. It 
will be perceived at once that this measure will 
be one of immense value. 

Messrs. Grisolle, CuUerier, Gruerard, Guillot, 
Beau, Chassaignac, Hardy, Tardieu, Broca, 
Brouchut, and others of the most eminent prac- 
titioners, have been appointed as a commission 
to prepare the most etficient plan for this pur- 
pose. 



M. CuUerier will probably take the place of 
M. Ricord, resigned, and M. Cusco succeed M. 
CuUerier, in the Hospital du Midi. 



A Poisoned Ping. — The Paris papers state that 
a gentleman who had, a few days ago, purchased 
some objects of art at a shop in the Rue St. Ho- 
nore, was engaged in examining an ancient ring, 
when he he gave himself a slight scratch in the 
hand with a sharp part of it. He continued 
talking with the dealer for a short time, when 
he suddenly felt an indescribable sensation over 
his whole body, which appeared to paralyze all 
his faculties, and he soon became so seriously 
ill that it was considered necessary to send for 
a medical man. The doctor immediately dis- 
covered every symptom of poison by some 
mineral substance. He applied strong anti- 
dotes, and in a short time the gentleman was in 
a measure recovered. The ring was found to 
be what was formerly called a death ring, in 
use in Italy, when acts of poisoning were frequent 
about the middle of the seventeenth century. 
Attached to it inside were two claws of a lion, 
made of the sharpest steel, and having clefts in 
them filled with a violent poison. In a crowded 
assembly, or in a ball, the wearer of this fatal 
ring, wishing to exercise revenge on any person, 
would take their hand, and when pressing it the 
sharp claw would be sure to inflict a slight 
scratch on the skin. This was enough, for on 
the following morning the victim would be sure 
to be found dead. Notwithstanding the many 
years since which the poison on this ring had 
been placed there, it retained its strength suffi- 
ciently to cause great inconvenience to the gen- 
tleman, as stated. 



A Neapolitan Hospital. — At Naples everything 
is in the most disgraceful confusion. " I went 
to the Hospital in theMercatello,'' said a friend 
to me, " this morning, and found a state of 
things which I should have deemed impossi- 
ble — dirt and confusion indescribable, a crowd 
of visitors interrupting the regular order of 
things ; women who ought not to have been 
there, and many of those busy unpractical sym- 
pathizers who would be much better in their 
own homes putting them in order. The Com- 
mandant told me he was disgusted with the 
whole thing ; that there was wholesale robbery 
carried on, and that, in short, he should be 
very glad if I would lend him a strong hand to 
cleanse the Augean stable.'' I am not at all 
surprised to hear this, for the normal state of 
the Naples Hospitals has been long most dis- 
graceful, as has been that of almost every insti- 
tution. Medical men have told me that the 
attendants have been in the habit of extracting 
profit from the patients in every possible way, 
robbing them of the last farthing, so that there 
is nothing which a poor person in the country 
dreads more than being sent to a Naples Hospi- 
tal ; and all this occurred under the saintly 
government of the Bourbons and the immediate 
inspection of the priests, who were responsible 
for the high moral and Christian qualities of 
those who were selected to relieve sufifering hu- 
manity! — Letter from Naples. [Lancet.) 



NOYEMBER 10, 1860. 



NEWS AND MISCELLANY. 



153 



Literary Madmen. — Histoire Litteraire des Fois 
(History of Literary Madmen) is the title of a 
somewhat curious book recently published by 
M. Delepierre, of Paris. In the commencement, 
the author remarks that the biographical his- 
tory of literary madmen, or "mad literary 
men/^ is, if properly executed, a more extensive 
undertaking than would, at first thought, be 
supposed. The difficulty turns upon the pre- 
cise definition of the word madman. What 
are the qualifications absolutely indispensable 
to constitute madness ? " Grreat wit,'^ we know, 
" is oft to madness near allied :" and the line of 
demarcation between them is, in not a few cases, 
so wavering and undefined as to be almost, if 
not entirely, imperceptible. If habitual lia- 
bility to hallucinations of a more or less intense 
and abnormal nature be held to be sufficient to 
qualify a man for the designation of madman, 
then many men of the most illustrious reputa- 
tion were undoubtedly mad. The names of 
Pythagoras, Numa Pompilius, and Mahomet, 
will at once suggest themselves as cases in 
point. Pascal used always to carry about with 
him a mystic amulet, in the form of a strip of 
paper covered with writing, which was found 
after his death sewn up in his garments ; and 
M. Lelut, a member of the institute, has writ- 
ten a treatise on the subject, in which he shows 
that this great man was to a certain extent 
mad. The same gentleman has further written 
another book, in which, according to M. Dele- 
pierre, he has established " calmly and scienti- 
fically^'' that what is called the demon of So- 
crates, must be regarded as nothing else than a 
state of ecstasy — a momentary madness. A 
further difficulty arises from the fact that no 
definite conclusion can be drawn from the cohe- 
rence or extravagances of a literary production 
las to the sanity or insanity of its authors. 

( M. Delepierre quotes several pieces of poetry 
^written by inmates of asylums, many of which 

. are quite as good as much that is published as 
poetry at the present day ; and it is notorious 
that, during an access of insanity, the patient 
not unfrequently breaks out into a strain of 

j lofty eloquence or true poetic imagination, the 
like of which he is, in his sane moments, utterly 

'' unable to produce. It is not, perhaps, so gene- 
rally known that the converse of this fact is no 
less true, and that men who are usually re- 
markable for the lucidity and elegance of their 
style are liable to occasional outbursts of inco- 
herence, wJpLich would do no discredit to the 
most accomplished professional lunatic. M. 
Delepierre cites the case of a physician at New 
York who, having just terminated a long and 
difficult investigation which required for its 
accomplishment the fullest exercise of the high- 
est mental powers, signalized its completion by 
writing to his sister in the following terms : 
" My Dear Sister : As the Cedars of Lebanon 



have been walking through Edgeworth Forest 
so long, you must have concluded that I have 
returned to the upper world ; but I am still in 
purgatory for James Polk's sins, which, if they 
do not end in smoke, surely have as good a 
chance of beginning that way as the ideas 
begin to shoot ; for if Thomas had not left his 
trunk on the cart at the depot, our shades 
would have been a deuced sight nearer to 
Land's End than Dr. Johnson said they would, 
by the time the Yankees rebelled,'^ etc. 

In order, therefore, to reduce a subject so ex- 
tensive to something like practicable dimen- 
sions, M. Delepierre continues his attention in 
the present essay to the cases of authors who 
have either been actually shut up in lunatic 
asylums, or Avho have, at least, shown them- 
sei'es, by universal consent, to be amply quali- 
fied for this distinction. The instances which 
he cites are, for the most part, those of men 
whose names are not generally known, and 
whose sole claim to distinction appears to rest 
upon their exceeding madness. 

Under the head of theological madmen, he 
seems inclined to place the authors of those 
devotional works, with singularly practical 
titles, which were so common in the times of 
the Puritans, of which Baxter's Hooks and Eyes 
for Believers' Breeches is a familiar example ; and 
he gives the titles of two French works of the 
same class, which are certainly not less racy 
and characteristic, and at the same time are 
less generally known, La Seringue Spirituelle 
pour les ames co7istipees, en devotion, and La Toha- 
tiere Spirituelle pour fair eterneur les ames devotes. 
A certain Greoffroy Vallee showed his insanity 
in a manner very unusual in the age in which 
he lived, by having a shirt for every day in the 
year, and by always sending his linen to be 
washed in Flanders, in a spring famous for the 
limpidity of its water. As if this were not 
enough, he must needs write an incoherent book 
on theology, which, says M. Delepierre, was 
burnt, together with its author, on February 
9, 1574. Descending to the present century, we 
find one J. A. Soubira, who found a mysterious 
and irresistible attraction in the number 666, 
and published, among other works, a pamphlet- 
having this number for its sole title, consisting 
of eighteen stanzas of five lines each, the fa,- 
vorite number being repeated at the end of each 
line. 

Under the head of literary madmen, we have 
mentioned one Thomas Bishop, the author of 
a drama, which was printed in London in 1811, 
with the title, " Koranzzo's Feast; or, the Un- 
fair Marriage ; a tragedy founded on facts, 2,366 
years ago, and 555 years before the birth of 
Christ." Among the dramatis persons are the 
King of Babylon, the King of Persia, Lord 
Strawberry, Doctor Pill, Madam Hector, four 
queens, three savages, and five ghosts. The 
stage directions for the final scenes are as fol- 
lows: — "One side of the stage represents a 
forest, part of which is in darkness. Two sofas, 



154 



NEWS AND MISCELLANY. 



Vol. V. No. 6. 



and the appearance of a clock. Three savages 
in the distance. '^ This piece was, unfortu- 
nately, never played, having been rejected, ac- 
cording to Mr. Bishop, in consequence of "some 
error.'' 

Of philosophical madmen, one of the most 
remarkable was Thomas Wirgman, a goldsmith 
of London. He was, certainly, very mad. He 
spent a fortune of £50,000 in publishing his 
works. They were printed on paper made ex- 
clusively for the purpose, each leaf being of a 
different color ; and, whenever any particular 
tint did not please him, he at once cancelled 
the sheet in which it occurred. Among other 
celebrated literary madmen discussed in this 
book, we find the name of Cruden, the author 
of the Concordance, who was partially insane 
at the time of writing his great work, and 
finallv died a maniac. — Puh. Circ. 



Blue Milk. — Dr. E. Eeichardt, of Jena, re- 
lates a remarkable instance of blue milk, which 
occurred in that vicinity within a circle of several 
miles during last fall. The milk, and especially 
the cream, after standing for some time,assumed 
a blue color, and the cause for this anomaly 
could not be attributed either to the food, want 
of cleanliness, or influence of locality. 

A careful examination into the facts, chemi- 
cal as well as microscopic, disclosed the pre- 
sence of a specimen of mould, most likely the 
Byssus Ccerulea, Linn. The coloring appeared 
at first to centre in a few isolated spots, and 
from them to spread through the cream down- 
wards, and the fibres of the plant could easily 
be removed with a pincette for microscopical 
examination. This accords fully with the re- 
sults of Braconnot and Bailleul, Lehmann and 
Fuchs, but refute the theory of E. Jones, who 
ascribes the blue color to an abnormal amount 
of phosphate of iron, as well as that of Kla- 
proth, who derives its origin from indigoferous 
plants. Vallot states that some authors ascribe 
this circumstance to the feeding on such plants 
as Hyacinthus comosiis, Butomus umhellatus. 



Digitalis in Delirium Tremens. — A few weeks ago 
we mentioned, in our periscopic department, 
4he treatment of delirium tremens by large 
^doses of tincture of digitalis. In the "October 
13th number of the Med. Times and Gaz., Dr. Bal- 
lard corroborates the statements of Mr. Jones 
as to the efficacy of this treatment, and gives 
several additional cases. "My own impres- 
sion,'' he says, "from what I have seen and 
heard from Mr. Jones is, that, in tincture of 
digitalis, we have a true counter-poison — an addi- 
tion to that class of mutually antidotal poisons 
of which opium and belladonna have been the 
most recent example. Alcohol is the remedy 
by which we counteract the depression pro- 
duced by digitalis ; the converse is also true ; 
digitalis is most remarkably an antidote for 
alcoholism." 



The Sustaining and Stimulating Treatment in 
France. — " It is curious," says the London Med. 
Times and Gaz., " to watch the opinions ex- 
pressed by the elite of French physicians on the 
effects of stimulants in diseases ; their dread of 
using them, and yet partial belief in and astonish- 
ment at their utility. They are still frightened, 
because they find no explanation of the fact. 
"We admit," says the Gazette Medicale, "that 
this has been our difficulty ; despite ourselves 
the instinctive fear of a fire (de I'incendie) pre- 
vented our acceptance of this treatment ; and 
we have always acted with the greatest timidity 
in giving generous wines in these kind of affec- 
tions. It was in vain that we saw the tongue 
become clear and the appetite increase under 
their influence ; prejudice and dread of some 
unknown evil always remained behind. Our 
judgment accepts the facts before we give our 
adhesion to them." 



Treatment of Ozcena. — Professor Borlee, of 
Liege, states his belief that ozoena is essentially 
a scrofulous affection, and may, just as oph- 
thalmia, constitute the only manifestation of 
the diathesis. The persons he has had to treat 
for this annoying infirmity have all manifested 
the lymphatic temperament in a high degree, 
exhibiting also indubitable signs of early scro- 
fula, or being descended from parents who have 
been themselves scrofulous. As the disease 
frequently occupies the mucous membrane in 
the deep-seated parts of the nasal cavities, in- 
jections form the best means of reaching its 
actual seat. The concreted mucosities must 
first be expelled by sniffing up or irrigating 
with water, this being repeated several times 
a-day in the intervals of injecting the medicinal 
substances. Of these latter, the author recom- 
mends especially nitrate of silver in the propor- 
tion of 8 or 10 grains to 8 oz. of water, tincture 
of iodine 1 oz. to 8 oz. of water, with 2 or 3 
drachms of iodide of potassium. — Presse Belgey 
No. 23. — Med. Times and Gaz. 



The Alleged Deaths hy Burns from Phosphorus- 
Matches, which have been going the rounds of 
the press, are pronounced to be hoaxes. Dr. 
J. Althaus, of London, has inquired into one 
of the cases that had happened, it was said, 

to a Dr. K , of B , Ehenish Prussia, and 

found that the gentleman in question was prac- 
ticing, in good health, and no such accident 
had happened to himself or any one in the 
neighborhood. 



The Oxalate of Cerium. — This article, as a re- 
medy for vomiting in pregnancy, has been 
attracting much attention, yet with the excep- 
tion of Dr. Lee's cases in the Philadelphia Hos- 
pital, but little on the subject has been reported. 
Dr. William Corson, of Norristown, informs us 
that where he has administered it the nausea 
and vomiting were increased. 



NOTEMBER 10, 1860. 



NEWS AND MISCELLANY. 



155 



A Literary Curiosity. — Among the curiosities 
of literature, says the London Medical Times and 
Gazette, is " Ouranoscopia/^ or a Survey of the 
Heavens, to which is added the Gout-raptures, 
augmented and improved. In English, Latin 
and Greek lyrick Verse. By Eobert Wittie, Dr. 
in Physick in both Universities, and Fellow of 
the CoUedge of Physicians in London, 1681. 
The principal medical allusions in "gout-rap- 
tures'' are the following : 

Venus went forth like Juno, 

And the like armour beared ; 
Both nights and morns was seen with horns, 

And daringly appeared. 
For beauty and for lustre, 

Mortals were wont t'adore her ; 
Her very touch yet now was such, 

That thousands fell before her. 
Her fresh wounds I observed 

Were easie to be cured ; 
But through neglect, or some defect, 

Prov'd hard to be endured. 
Though Mercury's no soldier, 

Jove found him serviceable, 
Who nimble quick to do some trick 

Or stratagem was able. 
I constantly observed it, 

With Mercury who contended, 
The nimble youth flew to his mouth. 

His tongue and chaps were rended. 
Some say wounds got by Venus, 

With Mercury were mended ; 
But when that fail'd, and nought prevailed, 

I oft those cures have ended. 



Philadelphia County Medical Society. — The next 
conversational meeting of this flourishing so- 
ciety will be held at the Hall of the College of 
Physicians, on Wednesday evening next, the 
14th instant, at 7^^ o'clock. This meeting, we 
predict, will be, in fashionable play-going par- 
lance, the *'^em" of the season, and will, no 
doubt, "draw a crowded house.'' Our predic- 
tion is founded both upon the interesting and 
practically important nature of the subject 
which has been selected for discussion, and on 
the popularity of the eminent gentleman who 
has kindly consented to introduce it. The sub- 
ject is, " The tendencies of the present day in re- 
gard to the doctrine of debility, and the treatment 
of disease hy stimulants'^ — a topic which will 
afford a capital field for reviewing '^ Brunonian- 
ism" as it prevailed for a short period, about 
the close of the last century, and which has lately 
been revived by Bennett, Forbes, Todd, etc. 
This revival of the so-called Brunonian system is 
attracting more or less attention all over the 
medical world, and it is predicted in certain quar- 
ters entitled to profound consideration, will 
revolutionize our generally received pathology, 
and established treatment of disease. The 
paper, introductory to the debate, will be pre- 
sented by Dr. Gross, the distinguished Professor 



of Surgery at the Jefferson Medical College, 
who will, no doubt, if we may judge of his pre- 
sent views from his voluminous writings, give 
a fair and conservative exposition of these ten- 
dencies of the age, which, in the opinion of 
some of the most eminent practitioners, are 
fraught with danger. 



Color of the Cerebral Substance in Relation to the 
External Pigment. — Meckel and Lecat long since 
noticed that the color of the cerebral substance 
was deeper in the negro than in the white man. 
The fact has been since verified, and if it has 
been denied by some, this has probably arisen 
from the means of comparison not having been 
at hand. M. Broca recently placed before the 
Anthropological Society the brain of a negro, 
and although this had laid in spirits more than 
two months, the coloring matter was distinctly 
cognizable, the white substance having a smoky 
tint. It was, however, the gray substance 
which was especially remarkable for its brown 
color. The pia mater, especially at the base, 
also contained patches of slate-colored pigment. 
M. Gubler, having had occasion to observe the 
above appearances in the brain of a negro, was 
induced also to examine whether analogous 
naodifications might not be observed in dark- 
colored persons among the white race ; and fre- 
quent comparison has convinced him that there 
is a true connection between the more or less 
deep color of the nervous centres, and that of 
the cutaneous pigment. Ehrmann has also 
noticed pigmentary cells in the cerebral mem- 
branes of the Malays ; and Virchow has ob- 
served that such coloration of the pia mater 
may be often observed in whites, though he 
does not seem to have connected it with the 
condition of the external pigment, as M. Gubler 
has done. — Moniteur des Sciences Med., No. 14. — 
Med. Times and Gazette 



Gambling for Charity. — It is proposed to secure 
a permanent endowment for some of the Lon- 
don hospitals, by allotting ten per cent, from 
the stakes of the Derby and Oaks races every 
year. It is said that it would yield a yearly 
income of nine thousand pounds. 



British and Foreign Medico- Chirurgical Review. — 
Dr. Sieveking has retired from the editorship 
of this valuable periodical. He is to be suc- 
ceeded by Dr. Ogle, of St. George's Hospital, 
a name already familiar to readers of the 
journal. 



Notes on Nursing, by Florence Nightingale, 
has re-appeared in a new edition, with a sup- 
plementary chapter. 



Ricord's Successor in the Hopital du Midi is 
to be M. Cusco, late of the Salpetriere. 



156 



NEWS AND MISCELLANY. 



Vol. V. No. 6. 



Expulsive Gingivitis. — The Paris correspondent 
of tlie Lancet, says : — In a recent communica- 
tion to tlie Academy of Medicine, M. Marchal 
De Calvi dwelt upon a not uncommon disease 
of the gums and alveola. This disease, hitherto 
unnamed, he proposes to call "expulsive gingi- 
vitis,'^ and as a suggestion of treatment, based 
upon a series of successful cases, is appended to 
the essay, I deem it worth mentioning. The 
affection consists in an inflammation of the 
gum and of the tooth-socket or its lining, most- 
ly commencing by an abscess, with a subse- 
quent slow inflammatory process. The tooth 
begins to emerge from its position in the jaw, 
deviating from the natural direction ; the gum 
recedes, and if the malady be unchecked, the 
former is completely ejected from its legitimate 
lodging. The disease is mentioned by English 
authors, but seems to be, if not unknown, at 
all events ufinamed in France, and constitutes 
the torment and bugbear of many a coquettish 
middle-aged lady. M. Marchal de Calvi enume- 
rates as the causes of this unsightly aflfection, — 
first, hereditary predisposition ; next, exposure 
to damp and cold, the neglect of cleanliness, 
and presence of tartar round the gum, dyspepsia 
or gastric irritation ; and lastly, pregnancy and 
lactation. The remedy found most successful 
in cutting short the disease in its early stage, is 
a watery solution of iodine, to be brushed twice 
daily over the gum : the solution at first to be 
used weak, and subsequently stronger and 
stronger, until a concentrated form is tolerated. 



At a late sitting of the French Academy of 
Sciences, Dr. Jules Cloquet produced a pair of 
boots made of the tanned skin of a boa-con- 
strictor. The material is remarkably strong 
and supple"; the scales have preserved their 
natural^ imbrication and color after the process 
of tanning, and the inside of the skin displays 
the marks of the scales in alternate reliefs and 
depression. Dr. Cloquet, on this occasion, ob- 
served that it would be desirable to make fur- 
ther attempts to introduce the skins of the in- 
ferior vertebrata into trade, seeing that, as to 
thickness and durability, they decidedly ofl'er 
greater advantages than those of the superior 
classes. He^ concluded by stating that he in- 
tended to give one of his specimens to the 
Museum of Natural History, the other to the 
Cabinet of the Zoological Garden of Acclimati- 
zation. 



The Polypharmacy of Japan. — The Japanese 
Doctors rival the most enlightened of our civil- 
ized Polypharmacal Physicians in their love of 
drugs. "After accouchement they especially 
play off this mania of theirs. Whether the 
birth be good or bad, they drench the woman 
with innumerable drugs, either to favor the 
lochial discharge, or to anticipate some distant 
complication. Directly the child is born they 
administer to the mother a tisan prepared of 
wood-ashes and tamarind-juice, or some other 



complicated decoctions. The abdomen of the 
woman is covered with a heap of ointments, 
whose composition varies according to the re- 
gions to which it is specially applied. These 
manoeuvres are continued for many weeks, al- 
though the mother enjoy the most perfect 
health. The child is also subjected to number- 
less manipulations : his whole body is covered 
with thick layers of oils, balsams, and juices of 
plants. •'' 



A Chinese Pharmacopceia. — " Toads' flesh cures 
diarrhoea; that of the gecTcs tuberculous aflec- 
tions. The flesh of the bat gives a long life to 
those who eat it ; its blood and bile have the 
reputation of curing syphilis, and its excre- 
ments are used in the preparation of certain 
pills. The dried and powdered skeleton of the 
scorpion possesses diaphoretic virtues, and 
cures rheumatism and syphilis. The brain of 
a horse makes the hair grow, its heart dried 
and powdered strengthens the memory, its 
bones remove sleeplessness ; — but they must be 
the products of a white horse. The marrow of 
an ass's bones introduced into the ear during 
sleep cures deafness ; rhinoceros' horn cures 
somnambulism. The urine of the tapir is an 
antidote against poisoning by copper.'' — Gaz. 
Hehdomadaire. 



The Phinoscope is a new instrument enlarging 
the "scope" of explarative vision of the physi- 
cian ; of course, as the name implies, it is a 
new optical instrument to explore the nasal 
jDassages. We now have 

Ophthalmoscopes, 

Auriscopes, 

Laryngoscopes, 

Ehinoscopes, 
and, without doubt, before twenty years are over, 
we will have 

Gastroscopes, 

Eectoscopes, 

Urethroscopes, 

Uteroscopes, 

Vesicoscopes, etc., etc. 
Who says we do not progress ? 

But, joke aside, the rhinoscope is reported in 
the Oesterreichische Zeitschrift fur praJct. Heilk. as 
of excellent service in facilitating catheterism of 
the Eustachian tube. 



Homoeopathy. — A German journal gives some 
details respecting homoeopathy. The number 
of homoeopathic physicians is 3,254, of whom 
1,612 are in America. The number of homoeo- 
paths in Germany is 471, and 35 for animals ; 
21 of the former are attached to hospitals. Of 
hospitals in Germany there are only 10, and 9 
of them are in Austria, 3 of the 9 being at 
Vienna. The journals which treat of homoeo- 
pathy in Germany are 8, 4 of them doing so 
scientifically, the rest for the ordinary public. 
The largest society of homoeopaths is in that 
country ; it consists of 230 members, and holds 



November 10, 1860. 



NEWS AND MISCELLANY. 



157 



annual sittings. In France there are 403 ho- 
moeopaths, in England 244, (with two hospitals 
at London,) in Spain 94, (with a hospital at 
Madrid,) in Belgium 20, in Holland 7, in Swit- 
zerland 34, in Italy 14, in the Scandinavian 
countries 12, in the Danubian principalities 4, 
in Eussia 67, (with a hospital at Moscow,) in 
Portugal 47, in Asia 4, and in Africa 6. The 
rest are in America. 



The Annual Meeting of the New Yorh Academy 
of Medicine was held on Wednesday evening 
last at the rooms of the Historical Society. 
Dr. John Watson delivered the annual address, 
of which the following is a short abstract : — 

The philosopher, said he, may be beyond 
others, yet he is never beyond the age in 
which he lives. Bacon, Luther, and others, 
while soaring above the common mind, were 
still subservient to the usages of those around 
them. The mass of men may be said to exer- 
cise no opinion at all of their own, but follow 
the beaten path ; and the physicians fall into 
this error as well as others. Men of this cha- 
racter are like the unskillful pilot, whose blun- 
der in a calm sea may do no harm, but when 
the tempest breaks over them this carelessness 
is the means of destroying themselves and 
others. 

He proceeded to explain what a true physi- 
cian should know, enumerating the benefits of 
a thorough education, carefulness, and the 
great necessity for scientific research ; but, 
passing from these, an ample education will not 
always guard against error and the delusion of 
hypothesis. 

In the choice of books, the physician is not 
tied down to any age or volume, but every thing 
is open to him, and the habits of study acquired 
in youth are always to be continued, and prac- 
tice would not always give perfection. Aber- 
crombie, Sydenham, and others, who have done 
so much to advance the science of medicine, 
did not obtain all their information from prac- 
tice, but from close study. He did not wish 
them to be too multifarious in their pursuits, 
but to have some object before them, and to 
follow it, as too many things will naturally 
weaken all. Although sometimes unsuccessful 
in our own pursuit, we still fall upon something 
that may improve us. The old alchemists, who 
were searching for the philosopher's stone and 
the manufacture of gold by artificial means, 
although unsuccessful in their pursuit, still dis- 
covered many things that the world has now to 
thank them for. He called upon them to be 
united in their labor, and to ask and give ad- 
vice, so as to benefit the cause. The motto of 
the physician should be like that of the old 
backwoodsman — ' Be sure you are right, then 
go ahead. ^ He was of opinion that the phy- 
sician should contribute to the press of the 
country, so as to allow all to judge of what was 
doing in the profession, and to permit the coun- 



try physician to benefit by the experience of the 
city practitioner. He then 23roceeded to glance 
over the traits necessary for a person to possess 
in order to become a student of medicine. 
Mildness, energy, courage, assiduity, were all 
necessary, and without them little could be ac- 
complished. A physician should always have 
a thorough knowledge of the world, and be 
able to understand the patient that he is called 
upon to cure. He is not to examine a patient 
as if he were a bale of goods, but should 
condole with him, and thus obtain his sym- 
pathy. 

The skillful use of such knowledge may be 
of great use to the suffering patient. The 
speaker here related many anecdotes of the 
manner in which several patients were restored 
to health by the cheerfulness and sympathy 
exhibited by their medical attendants. He 
then spoke at some length upon the benefit of 
exercising our mental faculties, and to let pass 
nothing that could be rendered useful to our- 
selves or others. The physician, particularly, 
should be of a penetrating character, and able 
to discern the difference between things that 
would not attract the notice of the casual ob- 
server. The trials and scenes that a physician 
sees, and comes in contact with, very frequently 
tend to make him sombre and quiet, if not 
dull ; and to counteract this, he should go into 
society, and enjoy the light pleasure of refined 
life, but by no means should he indulge in fri- 
volity, as steadiness of character is actually 
necessary to a physician both as student and 
practitioner. He should never permit his love 
of money to get the better of his usefulness ; 
and generosity should at all times be a striking 
trait of his character. Many instances were 
recorded of acts of benevolence and generosity 
on the part of good physicians, and many were 
the charitable acts that they do which never are 
known, or ever will be, in this world. In con- 
clusion he called upon the medical profession 
to continue in the performance of their duty, 
and thus obtain the gratitude and veneration of 
the world. 

At the conclusion of the discourse, Dr. Smith 
offered a resolution that the members return a 
vote of thanks to Dr. Watson for his address. 
The resolution was unanimously adopted. 

The officers for the ensuing year are as fol- 
lows : — President, Dr. John Watson ; Vice Pre- 
sidents, Drs. Foster, Buck, and Vanpelt ; Do- 
mestic and Foreign Corresponding Secretary, 
Dr. J. W. Grreen ; Trustees, Drs. Anderson, 
Wood, Kissam, Harsen, and Hubbard. 



The Medical College of Virginia, we learn from 
the Maryland and Virginia Medical Journal, is 
in a very prosperous condition. More than one 
hundred and thirty students have already ma- 
triculated. A hospital has been erected on the 
grounds of the college, which will be opened at 
new year. 



158 



COMMUJ^ICATIONS EECEIYED. 



Vol. V. No. 6. 



Health of Iowa. — A correspondent of the World 
writes as follows : 

One of the great sources of annoyance to east- 
ern people, who remove to the West, is the 
dread of intermittent and remittent fevers. 
These have been found to prevail in the new 
countries as a result of breaking up the soil, 
which exposes to the influence of the atmos- 
phere much decaying vegetable matter. But in 
countries so far North as the latitude of Du- 
buque, and particularly in high lands, where 
drainage is naturally good, these fevers are 
much less prevalent. Now in Iowa the bluffs 
rise from 200 to 300 feet, just back of the Mis- 
sissippi, and gradually increase to perhaps a 
height of 500 feet in the course of a few miles ; 
and at this elevation the country stretches away 
for hundreds of miles toward the Missouri river 
in rich rolling prairie, which affords the most 
perfect system of natural drainage. Hence 
those intermittent fevers, which are the scourge 
of the lowlands, are quite unknown in northern 
and central Iowa. The same is true to a great 
extent of Minnesota and Wisconsin. But it is 
not only in regard to these particular diseases 
that the State enjoys the blessings of health, 
but the United States census for 1850 assign to 
Iowa the third place in health among the States 
of the Union, placing it after Wisconsin and 
Vermont. 

The annual fall of rain in Iowa — situated, as 
it is, midway between the oceans — only slightly 
exceeds one-half that of the Eastern States, and 
three-fourths of this rain falls in the spring and 
summer. 



Digitalis in Delirium Tremens. — The article re- 
cently copied from an English journal on the 
administration of very large doses of the tinc- 
ture of digitalis in delirium tremens has at- 
tracted much attention. The English officinal 
tincture is of the same strength as that of the 
the U. S. Pharmacopseia. A practitioner of 
this city has informed us that he has frequently 
prescribed the tincture in drachm doses during 
acute inflammations, but the use of the article 
in half-ounce doses in conditions in which the 
arterial sedative effect is not apparently indi- 
cated seems extremely hazardous. Yet it is 
claimed that the effects of digitalis in inflamma- 
tory affections and in delirium tremens are 
exactly contrary. In inflammatory disease it 
subdues and regulates the pulse, whilst in deli- 
rium the pulse is by it increased in force and 
fulness. 



M. Vella has made new experiments on the 
effects of woorara ; and concludes therefrom 
that the woorara is capable of completely de- 
stroying the effects of a fatal dose of strych- 
nine. Consequently, the two poisons are an- 
tagonistic ; and what shows the fact very dis- 
tinctly is this ; that by mixing woorara and 
strychnine, the poisonous effects of these sub- 
stances, instead of being increased, are neu- 
tralized. — Med. Times and Gazette. 



Statistics are at present the rage in Paris. An 
enthusiastic proficient in that study lately cal- 
culated that fifteen milliards of men have perish- 
ed in the various wars which have been waged 
since the creation of the world. Carrying his 
calculation still further, he estimates the blood 
shed in these wars at 3,560,000 barrels ; and, 
taking the weight of each man at an average of 
100 lb., he concludes that 1,560,0000,00 lb. of hu- 
man flesh have been cut to pieces by hostile 
weapons. — Medical Times and Gazette. 



Verdict of Manslaughter against a Bone-setter. — 
Mr. Evan Thomas, bone-setter, of Liverpool, 
has been committed by the Coroner for the 
county of Chester and the magistrate of Birk- 
enhead, and is to take his trial on a charge of 
of manslaughter at the Chester Assizes. 



I have seen a testicle with a small firm cyst 
adherent to it, which contained a worm of that 
sort called vena medinensis, (Dracunculus, 
Guinea worm.) This is a worm of considerable 
length, with a smooth surface, and an uniform 
appearance; at the posterior extremity it ter- 
minates in a slender hook-like process, and at' 
the anterior is a rounded opening or mouth. 
This testicle had probably belonged to a man 
who had visited some of those climates in 
which the vena medinensis is found, and who 
had brought it over with him to this country. — 
{Bailie, 1808.) 



Gratuitous Services to Hospitals. — The Medical 
Literary Society (England) have recently dis- 
cussed the question of gratuitous services to 
hospitals, and have passed a resolution approv- 
ing the principle of payment to medical officers 
in public institutions. — Dancet. 



COMMUNICATIONS EECEIVED. 

CownecWcMif— Dr. A. Pratt, (with end.) 

Illinois — Dr. B. "Woodward. 

Iowa— 'Dr. E. J. Fontaine, (2.) 

Kentucky— Dv. Wm. Hays, (with end.) 

Louisiana — Dr. N. B. Benedict, Dr. M. L. Knapp. 

Minnesota — Dr. J. H. Murphy, (with end.) 

Mississippi — Dr. S. Morton, (with end.) 

JVew Jersey— Dr. J. S. Cook. 

New York—S, M. Pettingill & Co., Clark, Austin & Co., (with 
end. for Dr. Shattuck,) Dr. A. Norris, (with end.,) Dr. G. T. 
Elliott, Dr. Macnicholl (5,) Dr. C. T. Evans, J. Winchester, (with 
end.,) Dr. R. W. Clark, Dr. Lane, (with end.,) Dr. Brion, (with 
end.,) N. Y. Medical College, (with end.,) Dr. H. C. Murphy, 
(with end.,) Dr. E. S. Gaillard, Dr. B.'A. Mynderse, (with end.,) 
Dr. L. EUwood, (with end.,) Dr. J. Yan Ingen, (with end.,) Dr. 
J. L. Boulware, (with end.,) Dr. C. C. Smith, (with end.,) Dr. 
A, Hoff, (with end.,) Dr. A. Fowler, (with end.) 

Ohio— Dr. J. T. Leslie, (with end.) 

Pennsylvania — Dr. A. K. Seem, (with end.,) Dr. J. A. Reed, 
Dr. C. R. Cowdrick, (with end.,) Dr. I. R. Bucher, (with end,,) 
Dr. J. Kern, (with end.,) Dr. A. G. Cross. 

Rhode Island— Dx. E. M. Snow. 

Office Payments.— W. H. Cook, By Mr. Swaiue: Dr. C. T. 
Goodwin, Dr. Schofield, J. M. Maisch, (adv.,) Dr. McClenachan, 
(adv.,) Philadelphia Dental College, (ady.) 



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ADVERTISEMENTS. 



NEW YORK MEDICAL COLLEGE, 

JVo. 90 Siast 13tli street, near Fourtli Avenue. 

ELEVENTH SESSION, 1860-61. 



FACUl^TY. 

Robert Ogden Doremus, M. D., Professor of Chemistry. 

John Murray Carnochan, M. D., Professor of Clinical and Ope- 
rative Surg;ery. 

D. Meredith Reese, M. D., L.L. D., Professor of the Theory and 
Practice of Medicine and Medical Jurisprudence. 

B. I. Raphael, M. D., Professor of the Principles and Practice 
of Surgery and Surgical Pathology. 

A. K. Gardner, M. D., Professor of Clinical Midwifery and Dis- 
eases of Women. 

Jno. 0. Bronson, M. D., Professor of Anatomy. 

Chas. A. Budd, M.D., Professor of Theory and Practice of Mid- 
wifery. 

A. Jacobi, M. D., Professor of Infantile Pathology and Thera- 
peutics. 

B. L. Budd, M. D., Professor of Toxicology. 

*:i:* The Chairs of Physiology and Materia Medica are vacant, 
but will be filled in time for the opening of the Session. 

Fowler Prentice, M. D., Demonstrator of Anatomy. 

Thos. A. Whitney, Assistant Demonstrator. 

James H. Brush, M. D., Prosector to the Professor of Sur- 
gery. 

Simeon Abrahams, M. D., Assistant to the Professor of Sur- 
gery. 

The Preliminary Course by the Faculty will open on Monday, 
September 17th, with daily lectures and clinic[ues, and be free to 
all matriculants. 

The Regular Session for 1860-61 will commence on Monday, 
October 15th, and continue until the middle of March, with four 
lectures on each day, in addition to daily cliniques on Medicine, 
Surgery and Obstetrics, conducted by the Faculty. 

Demonstrative and Practical Teaching will be a distinctive 
feature in this School, especially in Chemical Analyses, 0;perar 
tive Surgery, and Practical Anatomy. 
FEES. 

For a full Course of Lectures, $105 ; Matriculation, $5 ; Demon- 
strator's fee, S5 ; For final examination for a degree, $30. 

Good boarding may be had in the vicinity of the College, at 
from $3 to $4 per week. 

Further information may be obtained by addressing the un- 
dersigned, No. 70 Union Place, New York. 

R. 0. DOREMUS, M. D., 

202 Dean of the Faculty. 



SULPHEH AMD MEDICATED 
VAPOR BATHS, 

(EXCLUSIVELY FOR LADIEs' USE.) 

BY S. F. RUSSELL, 

Sister and Successor to E. A. Car on, 
346 SOUTH THIRD ST., one door above Pine, 

PHILADELPHIA. 



DAILY WIHTER EXAMINATIONS 

IN CONNECTION WITH THE LECTURES 

Delivered in the Jefferson Medical College 

RY 

D. D. RICHARDSON, M. D., 

Senior Resident Physician to Philadelphia Hospital, Blockley, 
and Demonstrator of Anatomy in Philadelphia School of 
Anatomy, and 

JNO. W. LODGE, M. D., 

Formerly Resident Surgeon to Philadelphia Hospital, Elockley. 



LOMG ISLAND COLLEGE HOSPITAL. 

BROOKLYN, N. Y. 

THE COURSE preliminary to the session of 1861, will begin 
on the 18th of February, and the Regular Lectures on the 
18th of March, to continue till the middle of July. 
REGENTS. 
Hon. Samuel Sloan, Pres't. T. H. Rodman, Esq., Sec. 

COUNCIL. 
T. L. Mason, M. D., C. L. Mitchell, M. D., 

W. H. Dudley, M. D., J. H. Henry, M. D. 

PROFESSORS. 
Austin Flint, M. D., Practical Medicine and Pathology. 
Frank H. Hamilton, M. D,, Principles and Practice of Sur- 
gery. 

James D. Trask, M. D., Obstetrics, and Diseases of Women and 
Children. 
R. Ogden Doremus, M. D., Chemistry and Toxicology. 
Joseph C. Hutchison, M. D., Operative Surgery and Surgical 
Anatomy. 
John C. Dalton, M. D., Physiology and Microscopic Anatomy. 
De Witt C. Enos, M. D., General and Descriptive Anatomy. 
Edwin N. Chapman, M. D., Therapeutics and Materia Medica. 

DEMONSTATOR OP ANATOMY. 
George R. Smith, M. D. 

Every facility afforded for dissection throughout the year. 

vUnical Lectures daily, except Sunday, on Medicine, Surgery 
and Obstetrics, for which ample material is furnished in the 
lying-in wards and general hospital under the same roof. 

Professor Flint will give careful instruction in Auscultation 
and Percussion, and the art of Diagnosis in general. 

Professor Hamilton, in his Regular Course, will dwell espe- 
cially on Dislocations and Fractures, and in his Preliminary 
Course, will give a series of Lectures on Militanj Surgery. 

As far as practicable, instruction in all the departments will 
be by demonstration. 

Fees.— Full Course, l^lOO : Matriculation, $5; Demonstrators 
Fee, $5; Graduation, $25. 205 



The Course of Instruction will embrace a full series of Exami- 
nations, which will be held each day at 9 A. M. and 3 P. M. 

On the first of January the Review Examinations will be 
commenced, and continued during the lectures, thereby bring- 
ing the whole course delivered in Jefferson Medical College seve- 
ral times before the class, prior to their final examination by 
the Professors. 



ORDER OF EXAMINATION. 

Chemistry, 1 
Materia Medica, 
Obstetrics, J 



De. Richardson. 



Physiology, \-q t „ 

Practice of Medicine, / ^^' ^^^^^> 

By arrangement, our Class will be admitted to Dr. Agnew's 
Examinations on Anatomy and Surgery. 

Especial attention will be given to preparing students for the 
Medical Staff of the Army and Navy. 

No effort will be spared in contributing to the thorough prepa- 
ration pnd advancement of our class. 

Dr. RichPtrdson being Demonstrator of Anatomy at Dr. Ag- 
new's, will enable him to assist the Class in their anatomical 
studies. 

For further information, address 

J. W. LODGE, M. D., 
123 South Seventh Street, Philadelphia, Pa. 



198— ew 



Fee for the whole Course, $30. 



PKACTIOAL COURSE OF 
INSTRUCTION IN URINARY PATHOLOGY, 

By John W. Lodge, M. D. 

Dr. Lodge will commence a Course upon the above subject, 
about the 1st of November, to continue until the middle of Janu- 
ary, embracing a series of Twenty Lectures and Practical De- 
monstrations. . -i. X 

The object of the Course will be to extend an opportunity to 
those desirous of becoming familiar with the Chemical Physiology 
of the Urine, its various Pathological Deposits, their Microscopic 
Characters, Diagnosis, and Therapeutical indications. 

Arrangements have been made by which specimens of the 
most important urinary deposits occurring in the several Hos- 
pitals of this city can be obtained. 

For further information, apply to 

DR. J. W. LODGE, 
No. 123 South Seventh Street. 
Fee for the Course, $5.00. 
PUUdelpTda, Sept, 1860. 



THE 



MEDICAL AND SURGICAL REPORTER. 



WHo^LE SERIES, J PHILADELPHIA, NOVEMBER 17, 1860. { ^^l^'lfrf: 



ORIGINAL DEPAilTiVIENT. 

COMMUNICATIOIsrS. 

The Subcutaneous Application of the Me- 
tallic ligature to the Cure of Varicose 
Veins of the Leg. 

By K. J. Levis, M. D., 

Surgeon to the Philadelphia Hospital. 

The permanent interruption of the continuity 
of a varix is admitted to be the only means of 
its radical cure. Every variety of treatment in 
which the column of blood in a vein is merely 
sustained by external mechanical pressure, or 
by which the dilated vessels are compressed, is 
either palliative or temporary. 

With this admission, the accomplishment of 
the former object is certainly, therefore, a de- 
sideratum in surgery. But there is unfortu- 
nately connected with the usual operative pro- 
cedures for the obliteration of varicose veins a 
hazard to life which is too great to be incurred 
by such a recourse in ordinary cases, and the 
opinions and practice of surgeons at the present 
time are not favorable to the methods hitherto 
proposed for the radical cure of varicose dila- 
tation of the veins of the leg. 

The danger of operations for the cure of vari- 
cose veins is well known to be an uncontrollable 
phlebitis, with its consequences of erysipelas, 
pyaamia, etc. Notwithstanding these familiar 
dangers, the operation has undergone a varied 
appreciation of favor and condemnation, and 
has been from a remote period subjected to 
endless modification with the object of securing 
immunity from the risks which have ever attend- 
ed it. The rude procedures of Ali-Abbas, who, 
after cutting down upon the veins, violently tore 
them out, or of Pare, who dissected out the 
entire varicose trunks, were superseded by the 
milder methods of excising a portion of the vein, 
subcutaneous section, transfixing with needles 
or pins, enclosing in simple ligatures, etc. 
13 



At the present time, almost the only methods 
resorted to in the comparatively few instances 
in which an operation is advised, are Velpeau's 
pins and twisted suture, and the trifling opera- 
tion of applying caustics to the integument at 
points along the course of the veins. 

The former operation, although until recently 
the simplest and safest, has sometimes attend- 
ant evils and an occasional fatality which have 
prevented its general adoption. The latter, 
from its inefficiency, receives but little confi- 
dence ; my own experience in it being that but 
little benefit is gained from it apart from the 
temporary relief from rest in the horizontal po- 
sition enjoined while the consequent ulcers are 
healing. Very recently, and since I have been 
in the habit of ligating varicose veins with wire, 
Dr. Bozeman, of New Orleans, has published 
an account of his successful application of his 
'' button suture" to the cure of varicose veins. 

The many practical illustrations of the un- 
irritating quality of metallic threads in the 
tissues, which have occurred to me, suggested 
very early their application as a ligature in the 
common varicose dilatations in the leg, in which 
the ordinary means of ligation proves an irri- 
tant often serious in its consequences. The first 
opportunity for the treatment of varicose veins 
by a plan which I had devised, occurred in De- 
cember, 1859. Since that time I have repeated 
the operation with entire success, and attended 
with no unpleasant concomitants, in twenty- 
three cases. Some of these cases occurring in 
the wards of the Philadelphia Hospital, have 
been reported by the resident physicians, and 
the uniformity of the operations, and the pro- 
gress of all the cases, are such as to render their 
detail at present immaterial, the object of this 
article being simply to illustrate the peculiari- 
ties of the operation."^ 

To perform the operation it is important that 
the veins be distended, so as well to determine 



* See Med. and Surg. Reporter, Vol 4, p. 354, 420. 

159 



160 



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Vol. V. No. 7. 



ttieir outlines and avoid any risk of wounding 
them. This may be accomplished by putting 
a band around the limb above the knee, while 
the patient is in the erect position ; or this may 
be rendered unnecessary by performing the ope- 
ration whilst the patient continues standing. 
If the latter position be chosen, the patient, in 
order to have the leg at a convenient height, 
stands on a chair or table which is placed by a 
wall, against which he steadies himself. 

The points chosen for ligature are, first, the 
trunk of the saphena, at the highest point where 
there is evidence that, owing to the abnormal 
dilatation, its valvular structure is imperfect ; 
then the largest and most superficial veins, at 
places where they are most isolated; and, finally, 
those in the neighborhood of ulcers or ecze- 
matous eruptions of the integument. 

The only instruments and appliances essen- 
tial are a long straight needle, some silver or 
iron wire, adhesive or isinglass plaster, and a 
roller bandage. The needle should be straight, 
and two and a half or three inches in length, 
and diff'ering from the common surgical needle 
in having a sharp, round point, which perforates 
without cutting. In the absence of a needle pro- 
perly adapted for carrying the wire ligature, an 
ordinary fine darning needle will be quite 
suitable. 

Experience has proved to me that a straight 
needle is much more manageable for directing 
the point accurately than the usual curved one, 
and the policy of avoiding the cutting or spear 
point, where, as in the varicose state, even the 
innumerable veinous capillaries are often in a 
varicose condition, and which, when wounded, 
pour out blood profusely into the cellular tissue, 
is obvious. 

The wire had better be of a fine gauge, as 
number thirty, or finer. Pieces of adhesive, or 
isinglass plaster, the latter preferred, one or 
two inches square, are useful. The bandage 
may be six or eight yards in length, and two 
and a half inches wide. A wire-twister is a 
convenience but not an essential to the opera- 
tion. 

The patient being in a proper position, the 
operation is commenced by feeling for the edge 
of the vein to be ligated, and entering the needle 
perpendicularly until a point beneath the under 
surface of the v^ein is reached. Then the shaft 
of the needle is depressed and its point pushed 
horizontally beneath the vein until it makes its 
exit through the integument on the opposite 
side of the vein. This exit is facilitated by 



pressing on the integument with the fingers of 
the left hand over the point of the needle. After 
the needle is withdrawn, leaving a wire beneath 
the vein, it is reentered at the same orifice, but this 
time passes above the vein, traversing the space 
between the integument and the vein, and 
makes its exit at the point of original entrance. 

A slight pulling on the wire draws beneath 
the skin the loop of wire left on the opposite 
side of the vein, and all that is seen of the wire 
is its two ends projecting from the same orifice. 
Thus the vein is surrounded by a single wire. 

Proper care will avoid a risk of wounding the 
vein, but if there should be evidence that this 
has occurred, the needle ought to be at once 
withdrawn and another point for the operation 
selected. 

The accompanying outlines, to make the 
matter more explicit, illustrate the course of 
the needle and wire, and the manner in which 
the wire encircles the vein. 




Course of the needle. 




Wire surrounding the vein before being tightened. 

The wires are then pulled sufiSciently tight to 
simply constrict the vein, approximate its sides, 
and stop the circulation through its calibre. 
The object, be it understood, is not to induce a 
rapid ulceration through the coats of the vein. 
In this, my own practice difi'ers from the direc- 
tions generally given for the ligature of varicose 
veins, and on this peculiarity, perhaps, depends 
its apparently absolute safety. It is true that 
to insure a perfect closure of a varix it is neces- 
sary that it should be actually divided, but this 
division is best accomplished slowly, and only 
after the slight pressure on its walls has excited 



NOYEMBER 17, 1860. 



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161 



within a plastic exudation wliicli agglutinates 
them. Exposure of an opened vein to a pyo- 
genic surface is in this way with certainty 
avoided. 

The pressure made on the vein by pulling the 
ends of the wire is secured by twisting them. 
This may be done by means of the fingers, for- 
ceps, or the wire twister. A simple form of the 
latter instrument, which I prefer, being easily 
placed on the wires without threading through 
holes, as in the form of instrument generally 
used, is herewith represented. 



Wire Twister. 

The wire is finally cut ofl", leaving an inch or 
more, which is laid flat upon the skin ; the place 
of operation is covered with a small piece of 
adhesive or isinglass plaster, and a roller ban- 
dage envelopes the limb up to the knee. If an 
ulcer exists on the limb, it is to be simply 
covered, previously to the application of the 
bandage, with several thicknesses of dry lint. 

The patient rests horizontally, without dis- 
turbance of the dressing, for ten or twelve days. 
After this time all dressing is removed, and 
traction is daily made on the wires to accelerate 
their removal. But little more confinement of 
the patient is usually requisite. Decided relief 
from swelling of the varices is experienced, and 
he is frequently able to walk about with comfort 
long before the wires are removed. In one of 
my cases, a laborer had two wires remain in his 
leg for eight weeks, during the latter part of 
which time he continued his occupation with 
but little inconvenience ; in another case the 
ligatures, six in number, were all spontaneously 
removed on the fourteenth day. 

On removal of the bandage on the leg, the 
ulcer, if dependent on the varicose condition, 
usually seems to be really dried up, and cica- 
trizing rapidly follows. 

The satisfactory progress of the cases in which 
I have performed this operation induces me to 
advise a recourse to it as the usual resort in this 
much neglected atfection. As to the question 
of operation, and choice of cases for it, I would 
say operate in all cases where the varices are 
painful or where ulcers are produced or are kept 
up by them. 

It has been objected to any operation for the 
obliteration of varicose veins that, closing one 
trunk is liable to produce dilatation in a colla- 
teral branch, or merely transfers the affection 



to the deeper veins. Should the former occur, 
as it sometimes does, the simple repetition of 
the operation ensures a final success. The 
latter affection is unknown to me, for I look 
upon varix of the leg as practically a disease of 
the saphena vein and its branches, caused usu- 
ally by atony of the veinous walls allowing 
them to yield under the gravity of a colum of 
blood ; or to the engorgement caused by violent 
muscular contraction suddenly pressing the 
blood from the deep-seated veins into the un- 
supported superficial veins ; or occasionally to 
mechanical impediments to the returning circu- 
lation, as constriction at the saphenous opening, 
pressure of tumors, etc. 

The number of cases to which my experience 
has been limited, is, I am aware, not great 
enough to prove the invariable efficiency of the 
operation, or to establish its absolute immunity 
from danger, but these cases have illustrated to 
me very decidedly the superiority of the metallic 
ligature over any other material, and have con- 
vinced me that its application to this purpose 
will entitle the operation of ligation of varices 
of the leg to a more favorable consideration 
than it has hitherto received. 



Cases in Aural Surgery. 

By Laurence Turnbull, M. D., 
Aural Surgeon to the Howard Hospital. 
DEAFNESS FROM THICKENING OF* THE MEMBRANA 
TYMPANI, AND DISEASE OF THE EUSTACHIAN 
TUBE. 

On September 14th, 18G0, D. F. O , a gen- 
tleman from Georgia, applied to me for relief 
of deafness, from which he has suffered during 
the last five or six years. Numerous local ap- 
plications had been resorted to, various kinds 
of oil, etc., been dropped into the ear, without, 
however, producing much benefit. He had 
been, for a time, under the care of a traveling 
aurist, who, he stated, applied counter-irrita- 
tion over the mastoid process, and dropped 
some liquid in his ear ; but this also had not 
resulted in any amelioration of the difficulty. 

History and Etiology. — About five years ago, 
the patient had a fish-pond constructed, to 
which he resorted every morning for the pur- 
pose of bathing, plunging himself into the 
water head-foremost. The first disagreeable 
sensation, after continuing this practice for 
some time, was, when in his capacity as post- 



162 



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Vol. V. No. 7. 



master, he rumpled papers. The sensation was 
as if his teeth were "set on edge," by some dis- 
agreeable friction-sound in the paper. This 
remained for some time, but gradually dimin- 
ished, and in its place he had a constant sing- 
ing noise. He applied to his regular physician, 
who gave him some application to his ear, 
which, however, did him no good, and he 
found every slight cold increasing his distress. 

Present Symptoms. — The patient is able to 
hear conversation in a clear, loud, distinct 
voice, well. Low notes of music, and even the 
chirp of a cricket, he says, he is able to hear ; 
but general conversation in a room he cannot 
enjoy. When riding in a buggy, or in the cars, 
he can hear conversation better, which is ac- 
counted for by the elevation of voice necessary 
to overcome the noise when riding. 

On examining his ears by the speculum, I find 
them to be filled with oiled cotton; secretion 
scanty ; but the mucous membrane presents a 
natural appearance. The membrana fympani 
is thickened and opaque ; the outline of the 
malleus can be seen. Both Eustachian tubes 
are thickened, and admit air but imperfectly. 

The prognosis is unfavorable. 

Treatment. — Free dilatation of the Eustachian 
tubes by means of bougies or sondes, or the air 
douche. Apply to the membrana tympani a 
solution of nitrate of silver, gr. ii, to glycerine, 
,§i, every third day. Internally he is to use 
granules of bichloride of mercury, l-12th of a 
grain once a day. When last heard from, the 
noise in the ears was less, and the hearing had 
improved. 

RASPBERRY POLYPUS DEFECTIVE HEARING. 

On September 22, 1860, E. M. C, aged about 
20, a pupil of the University of Pennsylvania, 
brought a letter of introduction from his uncle, 
a distinguished physician, of Montgomery 
County, Pa., stating that his nephew was some- 
what defective in hearing, and requesting me 
to take him in charge. He had removed a 
small polypus from one of his ears about a 
year ago, and afterward had applied blisters 
and nitrate of silver. 

On testing his hearing, it was found that he 
could not hear the ticking of a watch, until 
closely pressed against the ear. He sufi^ered 
from a disagreeable discharge, and at times 
had considerable pain. There was no obvious 
thickening of the Eustachian tubes, nor were 
they filled with mucous secretions. 



On careful inspection, by bright sunlight, 
through a silver speculum, the whole of the 
epithelial coating of the meatus on the affected 
side was found to be removed, and the ear filled 
with flakes of mucus mixed with yellow pus. 
After removing this carefully, a polypus was 
found covering the membrana tympani entirely 
and filling up one-half of the meatus ; it was 
soft, and as the parts were in a highly irritable 
condition, I directed a mild astringent wash, 
and requested him to return on the 25th for 
the removal of the morbid growth. 

After cleansing out the ear, and drying it 
with cotton wool, I introduced a speculum down 
to the polypus, and taking a small piece of 
potassa cum calce, the patient holding the specu- 
lum in place and straightening the meatus, I 
carefully touched the surface only of the poly- 
pus with the caustic. At first there was no 
pain ; the color of the polypus changed imme- 
diately from a bright red to an almost livid 
hue and shrinking. After a few minutes, pain 
came on, which yielded, however, to injections 
of tepid water thrown in, in a full stream. 

There was a sense of giddiness produced. This 
I had noticed before, and in one case it was ac- 
companied with cough, and even pain. It is 
accounted for by the pressure of the polypus 
upon the membrana tympani and the chain of 
small bones, causing a movement of tension in 
the cavity of the vestibule, and this upon the 
auditory nerve, which in turn reflects upon the 
brain. 

Oct. 11. Discharge less, diminished one-half; 
renewed the application, and directed liquor 
plumbi sub-acet. half a teaspoonful to be dropped 
into the ear, after being carefully washed out. 

Oct. 17th, Polypus almost gone; discharge 
still less ; continue the treatment. 

CASE or DEAFNESS FROM MUCOUS ACCUMULATION 
IN THE EUSTACHIAN TUBE. 

Eobert W., aged 62, foreman of a cotton fac- 
tory, receiver and giver out of work, gives the 
following history of his case : 

He first felt his left ear aff'ected after a very 
cold term last winter, (1859,) a door opening 
right upon his ear, and ever since, he has had a 
humming sound, like that of a saw or planing 
mill, in that ear. On advice of his physician, 
he did nothing to the ear until warm weather 
set in, when the former syringed both ears. 
Nothing, however, was brought away, and his 
difficulty became worse. The patient was then 



November 17, 1860. 



COMMUNICATIONS. 



163 



advised by some one to use sweet oil (^ss.) with 
sassafras oil (5 drops) in his ear. This he did, 
but without obtaining relief. He next tried 
sweet oil and laudanum, then a solution of 
creasote, and lastly sulphuric ether, having 
seen a notice of the wonderful powers of the 
latter in one of the papers, all without avail. ^' 

When I saw him there was no pain. The 
hearing distance of the right ear was two feet ; 
of the left only two inches. The external mea- 
tus normal ; membrana tympani slightly opaque, 
of natural form ; the handle of the malleus is 
readily seen. The meatus is very narrow, re- 
quiring the smallest speculum, and even that 
pressed down. The Eustachian tube is found 
filled with mucosities. On shutting the nose 
and mouth and making the effort to swallow, 
but little air is found to strike upon the mem- 
brana tympani in the middle ear. 

Prognosis, favorable ; but the case will re- 
quire much more time for a permanent cure 
than it would, had it been taken hold of at once 
in the acute stage, which the physician, who 
saw the patient first, neglected to do. 

Treatment. — One-twelfth of a grain of the bi- 
chloride of mercury twice a day ; counter-irri- 
tation over the Eustachian tube, and dilatation 
of the same; with some astringent gargle. For 
the slight opacity of the tympanum, a few drops 
of a soltition of nitrate of silver, 1 grain to the 
ounce of glycerine, to be used, and the patient 
directed to take snuff occasionally. 



On the Use of Mullein ( Verbascnm Thapsus) 
in Chronic Bronchitis. 

By H. Wilson, M. D., 

Of Boonsboro', Maryland, 

Chronic bronchitis is universally admitted to 
be one of the most obstinate and difficult affec- 
tions with which physicians have to deal. This 
difficulty proceeds more from the locality than 
the nature of the disease ; more from a want of 
access to the mucous membrane of the bron- 
chise, than the absence of proper remedies to 
control the affection. Counter-irritation and 
the inhalation of chlorine, iodine, and expecto- 
rants, with such like means, have been used 
for centuries, but all physicians know, from ex- 
perience, that the benefits derived from their 
use are, merely temporary and palliative, and 
seldom bring about a radical cure ; still they 
are the best remedies which we have at coni- 

* I have used ether of late repeatedly in cases of deafness, but 
without any apparent effect. 



mand, and it is but right that we should avail 
ourselves of their medicinal virtues. The long- 
standing inflammation of the lining membrane 
of the bronchise seems to demand the contact 
and application of some powerful agent, in 
order to produce a new impression, and thereby 
change the morbid action of the part, before a 
healthy reaction ensues. 

The successful introduction of the probang, 
armed with a sponge and nitrate of silver, as 
employed by Dr. Horace Green, of New York, 
into the larynx and trachea, has been a great 
triumph for American science, and peculiarly 
adapted to accomplish the desired result. By 
this means he has been enabled to apply cau- 
terization to the diseased mucous membrane of 
the bronchise, and in a short time to destroy 
all traces of morbid inflammation. But how 
few are there who can do what Dr. Green has 
accomplished? The precise knowledge of ana 
tomy and skillful manipulation of the probang, 
which are required to introduce that instru- 
ment through such a narrow opening as the 
rima glottidis, will induce most surgeons to 
pause before the attempt is made. If such men 
as Professors Erichsen and Trousseau, with Dr. 
Marshall Hail, and other eminent European 
surgeons, declared that its introduction was an 
impossibility, without producing death, it can 
scarcely be expected that physicians and sur- 
geons, who have little opportunity of experi- 
menting on the living or dead subject, would 
undertake such a delicate operation. It is, 
therefore, of little practical benefit to the ma- 
jority of surgeons. 

The frequency with which bronchitis is met 
among clergymen and others, renders the dis- 
covery and use of any means which may be 
serviceable, either as palliative or curative, a 
matter of importance. For several years past 
I have been in the habit of using a remedy, 
which may not be new, but which far surpasses 
that of any other which I have tried in reliev- 
ing and, in many instances, entirely eradicating 
the affection. I refer to the leaves of the com- 
mon mullein, (verbascum thapsus,) dried, and 
smoked in a pipe. In that form of the disease 
in which there is dryness of the trachea, with a 
constant desire to clear the throat, attended with 
little expectoration and considerable pain in 
the part afl'ected, the mullein, smoked through 
a pipe, acts like a charm and affords instant 
relief. It seems to act as an anodyne in allay- 
ing irritation, while it promotes expectoration 
and removes that glutinous mucous which ga- 



164 



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Vol. Y. No. 7. 



tilers in the larynx ; and, at the same time, by 
some unknown power, completely changes the 
character of the disease, and, if persevered in, 
will produce a radical cure. 

In no respect are its beneficial effects more 
striking than in its power of immediately allay- 
ing the incessant desire of " clearing the 
throat,^' which is a source of constant annoy- 
ance to the patient, and which is so apt to dis- 
turb his rest at night. The remedy needs but 
to be tried to prove its efficacy. 

I will give two or three cases in point. A 
few months ago, the Eev. Mr. S., a minister, 
who had been preaching regularly for several 
years, came to my office and told me that he 
intended shortly to discontinue his vocation, as 
he found it impossible to preach in consequence 
of a sore throat. He said he had been suffering 
for several years, and now found his health 
growing rapidly worse. He regretted the ne- 
cessity very much, for many reasons. I ex- 
amined his case, and found he had chronic 
bronchitis. He told me he had been constantly 
under medical advice, and had tried every- 
thing, but nothing had done him any good, 
and now he had become quite discouraged. I 
recommended to him the mullein, which he 
promised to give a faithful trial. In two 
months from that time he returned to me, look- 
ing the picture of health, and in fine spirits, 
and told me he felt himself entirely relieved- 
He said money could not induce him to part 
with the remedy. Wherever he goes he carries 
his pipe, though he has had no return of the 
disease. 

Shortly after this case, I had that of a young 
lady, who had been suffering for two or three 
years. She had been under the care of an ex- 
cellent physician. In addition to the inflam- 
mation of the bronchi^e, which seemed inclined 
to extenlf to the lungs, her larynx and pharynx 
gave evidence of considerable inflammation. 
She also was annoyed with a constant hacking 
cough and a desire to clear her throat. The 
usual remedies had been tried in her case, but 
without any beneficial eff'ect. In two weeks' 
time, by means of her pipe and the mullein, 
she experienced wonderful relief, and is now, to 
all appearances, convalescent. Her fears have 
been allayed and her health restored. 

I, myself, for ten years, was a sufferer from 
chronic bronchitis. Every evening I became 
hoarse, and experienced great pain, dryness of 
the trachea, and a constant desire to clear my 
throat, which, in doing, not only disturbed my 



own slumbers but that of others. I tried cau- 
terization of the pharynx as low down as pos- 
sible with argenti nitras, counter-irritation, ex- 
pectorants, and inhalation, but all to no pur- 
pose ; finally, I commenced the use of the 
mullein, and nothing could have been more 
speedy and efficient in affording relief. I would 
recommend its trial as the best means of test- 
ing its virtues. 

The mullein may be gathered from almost 
any field at all seasons, and should be first 
dried, and the leaves smoked in a pipe like 
tobacco, at least two or three times a day. It 
is not unpleasant, and, unlike tobacco, requires 
almost constant smoking or drawing, or the fire 
will go out. 

The remedy is simple and harmless, but po- 
tent. It is one of those means which nature 
has so bountifully suj)plied, which are within 
the reach of all, and is but an evidence that we 
need not resort to chemical combination for all 
our most valuable remedial agents ; but, if we 
look around, we may find them at hand, ready 
for application. 



Imperfect Development of the Cranium of a 
Foetus. 

By C. M. Staple, M. D. 

Of Dubuque, Iowa. 

On the morning of the 30th of October last 
I was called to attend Mrs. D. in her second 
confinement. The os was fully dilated, and the 
unruptured membrane, at each pain, descended 
quite to the perineum. During the absence of 
the pains my finger detected, in place of the 
cranial bones, a soft pulpy mass, apparently of 
exquisite sensibility, as the foetus would, at each 
touch, bound away with sufficient force to 
make the mother cry out. At a loss to deter- 
mine the condition of things, I immediately 
ruptured the membranes, and then only after a 
patient examination could I satisfy myself that 
the head presented. In thirty minutes my pa- 
tient was delivered of a living female child, pre- 
senting the following peculiarities: 

There was an entire absence of the parietal 
and frontal bones, as far forward as the super- 
ciliary ridges. The deficiency extended down- 
ward, between the ridges, to the nasal bones. 

The antero-posterior diameter of this abnor- 
mal fontanelle was three and one-half inches, 
measuring from the inner table, and its trans- 
verse two and five-eighths. The integuments 
terminated abruptly at the edge of the cranial 
bones, as did, also, the duramater and arach- 



ISTovEiiBEii IT, 1860. 



HOSPITAL PEACTICE. 



165 



noid, leaving the pia mater as the only cover- 
ing of the cerebrum. This membrane was rup- 
tured posteriorly during delivery, and about an 
ounce of blood lost. 

The child was, in every other respect, well 
developed, and weighed eight pounds. It lived 
77 houi's, during which time respiration was 
performed with about half the usual frequency, 
and deglutition occasioned considerable diffi.- 
culty. 

The mother, a stout, hard-working woman, 
had, as is usual, an explanation for the phe- 
nomena in the shock she experienced from wit- 
nessing the execution of a criminal a few months 
previously. 



IlluBtrntinns 0f f nsptnl |rnrtitL 

PENXSYLYANIA HOSPITAL. 

Service of Dr. Gerhard. 

TWO CASES OF PNEUMOXIA COMPLICATED WITH 

TUBERCULOSIS. 

Case 1. The first patient suffering from these 
diseases is a man, about 25 years of age, who 
entered the hospital nine days ago. 

Though not well marked, his physiognomy 
presents the appearance of a man suffering 
from pneumonia. The nostrils are dilated, and 
there is a slight flush upon both cheeks — less 
marked, however, than ordinarily in pneumo- 
nia, because the patient is ansemic. The pa- 
tient breathes with his mouth open, a condition 
frequently found in cases of difficult respira- 
tion from various causes. There is a dull, 
heavy appearance of the eye. 

The patient has had very little cough, except 
when the trachea became irritated from the 
accumulation of bronchial secretions. There 
has been little or no expectoration. The brain 
is not effected ; there has been no delirium, no 
headache, no epistaxis. 

The pulse is frequent — 115 per minute ; the 
patient is free from pain, as is the case in many 
cases of pneumonia. The respiration is from 
30 to 40 in a minute. The frequency of respi- 
ration in pneumonia depends chiefly u]Don the 
extent of diseased lung. 

Phjslcal Examination. — There is dulness on 
the right side, more marked over the middle 
and upper portion of the lung. There is rude 
respiration at the upper part, and subcrepitant 
rales toward the middle. Yesterday the rales 
were finer. On the left side there is a trace of 
rude respiration. In front, the rude respira- 



tion is more marked and connected with sul- 
crepitant ronchus. 

There is, on percussion, some dulness on the 
right side. The patient has lost flesh for some 
time back, and is quite ansemic. All these are 
very suspicious indications, leading to the in- 
ference that, beside the pneumonia, the patient 
has tubercular disease. 

Treatment. — If it were our object to kill this 
patient, we would bleed him. It is one of the 
most important points in the treatment of pneu- 
monia to know when we are not to bleed. Ve- 
nesection should never be resorted to when the 
patient is feeble, and when the disease has pro- 
gressed several days. An ordinary pneumonia 
gets well of itself in ten to fourteen days. Now, 
it would be absurd to take blood from the arm 
of a patient on the eighth or ninth day, when 
the physical signs are already beginning to 
ameliorate, as in this instance ; we would there- 
by only weaken the j)atient and render conva- 
lescence slower. On the contrary, we must 
give this patient tonics and stimulants. One of 
the best articles of the latter class — indeed, the 
best stimulating expectorant in the asthemic 
form of pneumonia, whether primary or se- 
condary — is carbonate of ammonia. Of this 
the patient may take five grains every two 
hours. If the remedy should produce vomit- 
ing or gastric irritation, the dose must be dimi- 
nished, or the remedy be omitted entirely. 

Besides this, the patient is to take wine-whey 
and beef-essence. 



2. The second case of pneumonia — also 
a young man not yet thirty years of age — is 
still more markedly connected with tubercular 
disease. 

The patient has had a severe cough, with 
considerable expectoration, for eight months, 
and during that time has considerably ema- 
ciated. 

Eleven days ago he was taken with the acute 
attack, from which he is at present suffering. 
Since then he has had much cough, some pain, 
and considerable difficulty of respiration. His 
nostrils are dilated ; his cheeks are flushed. 
The flush of pneumonia must be distinguished 
from the hectic flush of phthisis. In the lat- 
ter, it is of a bright red ; while that of pneu- 
monia, as in this patient, is of a dark purplish 
or mahogany hue. 

The patient has had the rusty expectoration, 
ropy, thick, tenacious, characteristic of pneu- 
monia. It has, however, been more abundant 
than in pneumonia, on account of the tubercular 
deposit in the lungs, which is probably undergo- 
ing the process of softening. 



166 



HOSPITAL PRACTICE. 



Vol. V. No. 7. 



His pulse is moderate, 82 in a minute, and 
has lost all its febrile character. There is a 
slight exacerbation at night. 

On auscultation, we find, in the lower lobe of 
the left lung, strong subcrepitant ronchus — less 
so, however, than a few days ago ; it is be- 
coming ruder. 

The upper portion of the lung yields the same 
auscultatory signs, but the ronchus is larger. 

There are no signs of pneumonia whatever in 
the right lung ; but there is complete flatness 
or percussion over the upper part of the chest. 
This is the more significant, because it is on the 
right side. There is often a slight shade of dul- 
ness over the left side, owing to the position of 
the heart, which is quite natural, and it is fre- 
quently very difficult to tell, in cases of incip- 
ient phthisis, whether this dullness belongs to 
the natural condition, or is owing to tubercular 
deposit. But when the dulness occurs on the 
right sight, and so well marked as in the pre- 
sent case, it is always a grave sign. 

The j)atient, after entering the hospital, was 
at first placed upon spiritus Mindereri and wine 
whey ; a few ounces of blood were abstracted 
by cups applied over the chest. After having 
passed through the acute attack, this patient, 
like the former, is to be put on a generous diet 
and tonic and slightly stimulating treatment. 



PHILADELPHIA HOSPITAL. 

Reported by N. G. Blalock, of N. C. 

MEDICAL WARDS. 

Seryice of Dr. J. L. Ludlow. 

ENORMOUS ENLARGEMENT OF THE LIVER IN A 

YOUNG GIRL. 

J. McK. was born in Glasgow, Scotland, the 
10th of December, 1838. Her father died four 
years ago, in his 67th year, of cancer of the breast, 
as she claims to have been told by the physi- 
cian who attended him. Her mother has al- 
ways been healthy, with the exception of an 
habitual hacking cough. 

The patient states to have grown up healthy 
and robust to the age of 12. About this time 
her family emigrated to Canada ; and soon after 
her arrival she took a severe cold, that gradu- 
ally degenerated into a chronic pulmonary af- 
fection, and made an invalid of her ever since. 
In her fifteenth or sixteenth year, she and her 
family experienced much trouble, which aggra- 
vated very much her ailment. She removed to 
Cleveland, Ohio ; but, after eight months' resi- 
dence there, her friends seeing that she was 
growing worse, advised her to come to Philadel- 
phia. Once here, and unable to provide for her 
comfort and medical assistance, her friends ad- 
vised her to go to the Pennsylvania Hospital, 
where she was admitted a year ago last June ; 



where, she says, she had been six months 
under the care of Drs. Gerhard, Meigs, and 
others. 

The 5th of January, 1860, she was admitted 
into the medical wards of the Philadelphia Hos- 
pital ; and sixteen days after sent to the out- 
wards, very much relieved of her cough. This 
cough, she says, ceased completely, two or three 
months after. 

On the 5th of May last, she was sent again 
to the medical wards suffering from a very se- 
vere attack of jaundice. Then, for the first 
time, she felt a dull, heavy pain in the region 
of the liver, and ever since, this viscus has kept 
steadily increasing in size, and vitiating her 
system, in spite of all the eflPorts that Drs. Da 
Costa, Judson, and Ludlow, (successively at- 
tending her,) have made to check it. 

She now presents a very painful but interest- 
ing subject of study to the medical student ; 
her appearance that of a woman ten or twelve 
years older, greatly emaciated, with jaundiced 
face and eyes : dry tongue ; lower limbs always 
more or less swollen, and sometimes painful. 
The liver is four or five times the normal size, 
extending above to the ensiform process of the 
sternum, which it makes protrude through the 
skin by its pressure ; below, to within a quarter 
of an inch of the umbilicus ; to the left, in 
front, to the region of the spleen ; behind to 
the spinal column. Over this space, as well as 
over the chest, the skin is exceedingly tense ; 
and the patient suffers very much from any mo- 
tion. 

Her sleep is very much interrupted, and her 
catamenial functions have ceased since she 
was attacked with jaundice. Her bowels are 
regular. 



SURGICAL WARDS. 

Service of Dr. D. Hayes Agnew. 

OPERATION FOR THE RADICAL CURE OF OBLIQUE 

INGUINAL HERNIA. 

In the radical cure of hernia, all the methods 
devised have had in view the accomplishment 
of the same end, namely, the closure of the in- 
guinal canal by adhesive inflammation ; to this 
end were directed the processes of Bonnet, 
Gerdy, Velpeau, Wurtzer, etc. The method 
employed by the latter has been considered by 
some surgeons the most effectual ; but in his 
hands. Dr. Agnew remarks, it has failed to 
offer a permanent obstacle to the reproduction 
of the disease. He had, after some thought, 
constructed an instrument the application and 
the principle of which, he hoped, might prove 
more advantageous. It consists of two semi- 
cylinders of metal three and a half inches in 



n 



NOYEMBER 17, 18G0. 



HOSPITAL PEACTICE. 



167 



length, on the upper surface of the under one 
of which, on either side, is a grooved director. 
These semi-cylinders can be separated from 
each other by a screw passing through the han- 
dles. See Fig. 1. 

Fig. 1. 




In addition, there is required a long spear- 
pointed needle, supported on a good bone han- 
dle, curved at the end, with an eye, and having 
a small bulb or swell on the shank, situated as 
far from the point as is equal to the length of 
the cylinders. See Fig. 2. 

Fig. 2. 

Application of the Instrument. — The J' 
patient, a Grerman, 55 years of age, f 
with an oblique inguinal hernia of seven / 
teen years' standing, after having been 
prepared for the operation by opening 
his bowels freely on the day previous, 
was placed upon a table and etherized. 
A portion of the upper part of the 
scrotum being pushed by the finger 
into the external abdominal ring, was 
followed by the instrument, the blades 
being closed and passed up along the 
canal until the point could be felt 
through the abdominal parietes, near 
the internal ring. The screw on the han- 
dle being now run down, the blades 
were separated from each other, and 
the needle, armed with a silver liga- 
ture, passed along the groove on one 
side and brought out through the walls 
of the abdomen at the upper end of the 
instrument. The wire was then re- 
moved from the eye of the needle and 
the latter withdrawn, threaded with the 
other end of the same wire, and then 
carried along the other groove of the 
instrument and made to transfix all 
the structures between the canal and 
the surface, coming out a short distance 
from the first. The needle being un- 
threaded and removed, the two ends of 
the wire were drawn and twisted together over 
a small roll of lint. The object thus far has 
been to retain this plug of integument in the 
inguinal canal. Fig. 3 will convey an idea 
of the relation of parts and the position of the 
siver wire, such as would be seen were the in- 
strument and anterior wall of the canal re- 
moved. 

The next step consists in taking several needles, 
armed, some with silk, and others with wire, and 



passing them across the canal between the 
blades of the instrument, thus avoiding the cord 
which will be behind the posterior blade, and 
also ensure the lodging of the plug in the canal, 



Fig. 3. 



Fig. 4. 





and not external to the tendoTi of the external ob- 
lique muscle. The first transverse ligature should 
be near the internal ring, and others at short 
intervals as low as the external ring. The in- 
strument is now withdrawn, and Fig. 4 may 
be supposed to convey an idea of the appear- 
ance of the parts. 

A compress is next laid over the part, and 
confined by a bandage applied with a moderate 
degree of firmness ; or a truss might be employed 
for the same purpose, the object being to produce 
adhesive inflammation. The transverse liga- 
tures must be carefully watched, and removed 
one at a time, so as to maintain the adhesive 
inflammatary action and prevent the forma- 
tion of pus. Here the judgment of the surgeon 
must guide him. 

The result of this case Avill be given, and fur- 
ther comment from the doctor on the subject. 

FALSE JOINT, OR PSEUDARTHROSIS OF THE HUMERUS. 

Remarks — Varieties. — The ends of the fracture 
may become rounded off and encrusted by a 
fibro-cartilaginous substance. 2. The ends may 
become connected by fibrous or fibro-cartilage. 
3. The end of one fragment may become rounded 
and the other hollowed out into a cup-shaped 
cavity, surrounded by something resembling a 
capsular ligament, and lined by an imperfect 
synovial membrane. 

Causes may be various, either local or con- 
stitutional. Under the former head . may be 
enumerated too frequent or badly applied 
dressings ; under the latter, organic disease, 
feeble constitution, defect in the constitution of 
the blood, etc. We should not conclude too 
soon that a fractured bone will not unite, be- 
cause the union may be only delayed. 

Treatment. — Different plans have been sug- 
gested — blistering by Dr. Hartshorne, seton by 
Physic, pegs by Dieftenbach, drilling by Brain- 
ard, apparatus of Prof. Smith, of University of 
Pennsjdvania, resection of the ends of the bone, 
electricity, galvanism, etc. 

The patient upon whom the operation was per- 
formed was a man 34 years of age, who had the 



168 



HOSPITAL PEACTICE. 



Vol. V. No. 7. 



humerus fractured about two inclies above the 
elbow joint two years ago, and from some cause 
or other, most likely bad treatment, it has not 
united, forming in this case the third variety 
given above. 

Operation. — First denuded subcutaneously the 
ends of the bone, then drilled several holes in 
different directions, and finally a hole in each 
fragment, with a drill armed with a canula. 
Eemoving the drill and leaving the canula, a 
small quantity of tinct. of iodine was injected 
into the holes of the bone, after which the canula 
was withdrawn. The arm was then placed in 
an angular splint, moulded to the limb. 



UNIVEESITY OF PENNSYLVANIA. 

MEDICAL DEPARTMENT. 
Service of Prof. Pepper. 
PARALYSIS AFTER SCARLATINA ; SEQUELS OF SCAR- 
LATINA. 

The patient is a little child, three years of 
age, who had scarlatina in April last. About 
this there can be no doubt, as the physician, 
who then attended the child, pronounced it 
scarlatina, and from the description of the rash, 
which the mother gives, it can hardly have 
been anything else. The child had not much 
fever accompanying the disease. 

The child was kept in the house for three 
months, except once, about six days after des- 
quamation, when the little boy was injudicious- 
ly allowed to go in the yard. The patient had 
little or no sore throat. 

Three weeks after the scarlatina, some dropsy 
came on, which persisted some time. 

Two months after the first attack the child 
lost the power of motion of the whole of the 
right side. It has, however, gradually recov- 
ered, but still is unable to use the right arm 
with any degree of vigor, and in walking drags 
the limb of that side in the manner, character- 
istic of paralysis. 

There are several points of interest connected 
with this case. 

First. It _ teaches the great importance of 
keeping patients, attacked with scarlatina, in the 
house, and carefully guarding them against the 
changes of temperature and weather for a con- 
siderable time after desquamation ; three weeks 
is the shortest period, and in spring and fall, 
especially in months so changeable as April, 
it should be much longer. 

One of the chief causes of dropsy following 
scarlatina is congestion of the kidneys, accom- 
panied by albuminuria, the result, often, of un- 
timely exposure. 

A second point of interest is presented by the 
palsied condition of the patient. I have seen 
two or three cases of paralysis following scarla- 
tina, in one of which there was hemiphlegia ; in 
the other general loss of motion and sensibility. 



The latter case was that of a little boy, in 
whom the scarlatina had been accompanied by 
excessive sore throat. The loss of motory 
power was sufiicient, in his case, to affect the 
sphincters, which were imperfectly contracted. 
The back of the neck had commenced to swell 
much, soon after the attack, and the swelling 
gradually increased until, on close examination, 
it was found that the neck was evidently anchy- 
losed. In this case the inflammation about the 
throat had obviously extended backward to the 
pharynx, finally involving the cervical vertebrae, 
and causing intervertebral deposit, pressing 
upon the spinal cord, produced the general par- 
alysis. ^ 

But in the case before us it does not appear 
that the disease has been of the anginose va- 
riety, or that, indeed, there has been sore throat 
to any extent. Beside, there was too consi- 
derable a period between the attack of scarla- 
tina and the occurrence of the paralysis to 
favor the assumption that this case is anala- 
gous to the one referred to. We must, hence, 
look to some other cause. 

The mother states that the paralysis came on 
suddenly, and was ushered in by a convulsion. 
This leads us to suspect that the cause of the 
paralysis is situated in the brain, although, of 
course, it is impossible to say what is the pre- 
cise anatomical lesion. 

In cases of renal dropsy, accompanied by 
albuminuria, the excretion of the urea from the 
blood is generally more or less interfered with, 
and we have the condition induced, known as 
ursemia, the most prominent symptoms of 
which are dilatation of the pupils, stupor, con- 
vulsions, and death. 

Ursemic poisoning is most apt to afiect the 
brain, and as the patient has had dropsy, and 
soon after convulsions, w'hich ushered in the 
paralysis, it is very probable that the latter has 
been caused by some pathological change in 
the meninges of the brain, or the brain itself; 
effusion perhaps of plastic materiakor serum. 
But, as already stated, it is impossible for any 
one to know the exact pathological changes. 

The prognosis is not so unfavorable as might 
at first sight appear. The recuperative powers 
of nature in a child at this age are so great 
that the difficulty may be measurably re- 
moved, and it is upon these that we must 
chiefly rely. In a therapeutical point of view, 
very little can be done. To aid in the absorp- 
tion of any effusion that may exist, a half a 
grain of iodide of potassium, three times a day 
may be given, and mild counterirritation be ap- 
plied to the neck. 



PLEURO-PNEUMONIA IN A BOY THIRTEEN YEARS OF 
AGE RESULTS. 

The patient presented himself at the clinic 
with substantially the following history : 
Two years since last August, he was first 



November 17, 1860. 



HOSPITAL PEACTICE. 



169 



taken with a " bad cold ;'^ he had fever, went 
to bed ; had pain in the right side ; a great deal 
of cough, with considerable expectoration, of a 
pinkish, brick-dust color. He recovered from 
this attack. There has been occasionally more 
or less cough, and he now expectorates about a 
wineglassful of white matter. 

Present Condition. — He spits blood occasional- 
ly ; is as stout as before, apparently, but the 
muscles are rather flaccid. He has dyspnoea 
when he exerts himself. 

On measuring the chest there is a difference 
of nearly an inch and a half between the two 
sides; the right side being the smaller. There 
is, on percussion, a great deal of flatness and re- 
sistence on the right side, w^hich is contracted, 
while the left is preternaturally bulging. The 
right shoulder hangs. 

The patient then has evidently a pleurisy of 
two years standing ; but besides this he must 
have had pneumonia, as he had much fever 
and bloody expectoration. There is now ex- 
tensive effusion in the right thoracic cavity, 
with adhesions and thickening of the pleura. 

The extensive contraction of the chest, fall- 
ing of the shoulder, etc., as a consequence of 
pleurisy, occurs with less frequency in grown 
people than in young persons, because in the 
former the parts, ribs, etc., are less yielding ; 
but from the same reason it is easier removed 
in children than in adults. 

^ Auscultation yields a little bronchial respira- 
tion at the upper part of the right lung, some- 
what blowing, but there are no signs of a 
cavity. 

The patient has occasionally expectorated 
blood ever since the attack of pleuropneumonia. 
It may be that he has had an abscess, not 
tubercular, but an abscess accompanying or 
following the pneumonia. Although it has 
often been denied that inflammation of the 
lungs ever resulted in suppuration or abscess of 
the lungs, recent observations have shown that 
abscesses may occur with pneumonia. Graves 
and Stokes have reported such cases, and I have 
seen them myself; in one of which at least one- 
half of the affected lung suppurated away. 

The treatment in this case must be building 
up. ^ Tonics and nutritious food are indicated. 
Heis to take 8 drops of the syrup of the iodide 
of iron three times a day in a tablespoonful of 
water, an hour after meals. 

It is scarcely necessary to remark that the 
leftlung shows on percussion and auscultation 
decided supplementary action. There is ex- 
aggerated puerile respiration. 

The prognosis must be considered favorable, 
as there is no tubercular disease. 



JEFFERSON MEDICAL COLLEGE. 

Service ol Prof. Gross. 
Reported by N. G. Blalock, of N. C. 

POPLITEAL ANEURISM DIGITAL COMPRESSION — 

. LIGATION. 

The patient is a negro man, 38 years of age, 
a barber. Nearly two years ago he discovered 
a small pulsating lump or tumor in the region 
above named. It excited but little notice at 
first. At length, however, it became larger, 
mechanically causing flexion of the leg, and 
was also the seat of much pain. Two weeks 
since he entered the hospital of the College for 
treatment. 

Digital compression was kept up for four and 
a half days without cesssation, and the patient 
was given acetate of lead, opium, and vera- 
trium . 

The compression was at the femoral artery, 
where it passes over the pubic bone. The pa- 
tient being somewhat exhausted by the com- 
pression, although it was progressing favorably, 
(for the tumor had decreased very much in 
size and was much denser,) the compression 
was discontinued. For the relief of the aneu- 
rism, Prof. Gross ligated the femoral artery 
about 4J inches below Poupart's ligament, 
just at the point where the sartorius muscle 
crosses the artery. The incision was made 
about three inches in length. The patient be- 
ing fat, it was made long to allow for access to 
the vessel. After reaching the artery and 
clearing it of the vein and nerves, an aneuris- 
mal needle, armed with a ligature, was passed 
under from within outwards. It was then firmly 
and carefully tied. The patient was ordered a 
good diet. 



POTT S DISEASE OF THE SPINE. 

The patient is a boy, five years of age ; he 
has been suffering for six months with disease 
of the dorsal region of the spine, producing a 
slight curvature backwards. This disease 
generally occurs in persons of a scrofulous or 
strumous diathesis. If the patient be allowed 
to walk about or keep in the erect posture, the 
curve would become much greater, so as to pro- 
duce what is commonly called pigeon breast. 
To prevent this the patient was ordered to be 
kept in the recumbent posture and use the iodide 
of potassium, and occasionally mercury. The 
diet was ordered to be well regulated. The 
actual cautery was applied to the diseased part, 
after which cold water dressing. 



170 



HOSPITAL PEACTICE. 



Vol. V. No. 7. 



NEW YOEK HOSPITAL AND CLINICAL 
EEPORTS. 

MERCURY IN PRIMARY SYPHILIS. 

Dr. James E. "Wood, of Bellevue Hospital, a 
few days ago, after a very interesting and ex- 
hausting lecture upon ununited fracture, and 
an operation upon a case in point, exhibited to 
his class a most interesting case. It was that 
of a young girl, sixteen years old, a victim of 
hereditary syphilis, and a most pitiable specta- 
cle. At the age of nine months her uvula and 
part of the soft palate had ulcerated away. 
Soon followed the loss, in part, of the superior 
maxillary bones. Soon, again, melted down 
the vomer, turbinated bones, the cartilages of 
the nose, and a great part of the nasal bones. 
At the time of her exhibition to the class, her 
legs, arms, and face were covered, more or less, 
with syphilitic rupia. She had partial anchy- 
losis of one elbow, and the "corona Veneris, '^ 
with marked eburnation of the os frontis. She 
was gradually improving under the treatment 
indicated in such cases. In the course of his 
remarks upon this case, Dr. Wood stated that 
he knew the mercurial treatment to be the only 
one in any degree safe in primary syphilis : and 
that he felt bound to say that, in his opinion, 
the physician who treated it without mercury, 
in the absence of some special contraindication 
to its use, was deserving of censure. Now all 
this is diametrically opposed to what I know is 
inculcated in one, at least, of the best schools 
of medicine in this or any other land. " Who 
shall decide when doctors disagree" so utterly, 
and upon so important a point? 

LEPROSY, SYPHILIS, AND STRUMA. 

Apropos to the above, the venerable and dis- 
tinguished Dr. Valentine Mott, of the Univer- 
sity Medical College, made lately, in one of his 
admirable clinical lectures, what to me was a 
striking and novel statement. It was to this 
effect: that to his mind the conviction was irre- 
sistible that leprosy was the great progenitor 
of both syphilis and struma ; that they were 
all three essentially the same disease. His 
conviction, he stated, was founded upon ex- 
tensive observations which he had been ena- 
bled to make upon leprosy in its various phases, 
while traveling in the East. The analogy be- 
tween leprous and syphilitic sore throats and 
skin diseases he instanced as being particularly 
striking and complete. He did not enter at 
large into the subject, but threw out these re- 
marks merely in a suggestive way. 

The question, on this point, is an interesting 
one in a scientific light, and the expression of 
an opinion by so high authority must necessa- 
rily carry much weight with it. Cannot some 



one else, competent from observation, expe- 
rience, and talent, who has given attention to 
the subject, let us have the result of his thought 
and research upon this point ? 

IDIOPATHIC TETANUS FAILURE OF QUININE GOOD 

EFFECTS OF STIMULATION. 

There is now in one of the wards of Bellevue 
Hospital, under the supervision of Prof. Alonzo 
Clark, a case of successfully treated idiopathic 
tetanus. The case has been quite well marked, 
there having been present both trismus and 
moderate opisthotonos. The patient, who is a 
young man about twenty-three years old, was 
put first on the use of quinine in five grain 
doses every hour. This treatment was contin- 
ued for thirty-six hours, at the expiration of 
which period no improvement having ensued, 
but, on the contrary, the patient having become 
worse, he was put upon the free exhibition ot 
whisky. Improvement immediately followed. 
Whisky was for some reason dropped, and 
opium exhibited in large doses. The disease 
having immediately thereupon become again 
more threatening, recourse was again had to 
whisky, twenty ounces being given per diem, 
together with moderate doses of opium. This 
treatment was persisted in with marked benefit. 
The patient is now convalescent, the whisky 
having been obviously the main instrumentality 
in effecting this result. The quinine treat- 
ment had, in this case, a fair trial, and failed 
totally. Surely, if there be any specific virtue 
in quinine in cases of tetanus, its exhibition at 
the rate of a hundred and twenty grains in 
twenty-four hours, ought to develop some of 
it. King Alcohol appears to reign supreme in 
these cases. 

INTERESTING POST-MORTEM EXAMINATION AFTER 
C^SARIAN SECTION. 

I witnessed the other day a post-mortem 
examination of more than ordinary interest. It 
was that of a woman who had had the opera- 
tion of Caesarian section performed on her five 
days before by Dr. Fordyce Barker, of Bellevue 
Hospital. The operation was performed pri- 
vately, at the hospital, very skillfully it is said. 
The child was saved, and for some time the 
mother appeared to be in a fair way of recovery. 
She was kept under the influence of morphia 
to the degree just short of narcotism, in order 
to avoid peritonitis, and given beef tea and 
brandy. Vomiting was at one period trouble- 
some, but was arrested by adding dilute nitric 
acid to the beef tea. Dr.' Barker remarked, en 
passant, that dilute nitric acid often acted ad- 
mirably when the stomach had become intole- 
rant from exhaustion. She appeared to be 
doing well up to the night before she died, when 



NOYEMBER 17, 1860. 



HOSPITAL PEACTICE. 



171 



she began to sink, without any marked symp- 
toms save those of a typhoid character. She 
died on the fourth day after the operation. This 
was her fourth pregnancy. On the occasion of 
her first accouchement, ten years ago, the labor 
was difficult, but the child was born alive per 
vias naturales. On the occasions of the next 
two, the medical attendants were compelled to 
resort to perforation and evisceration. Toward 
the close of this, the fourth pregnancy, the 
attempt was made to save both mother and 
child by Caesariotomy. She was perfectly intelli- 
gent to the last, and complained very little of 
pain. 

The examination was made about twenty-five 
hours after death. The abdomen was greatly 
distended, and upon opening it, much foetid gas 
escaped, and the walls collapsed. There did 
not appear to be the slightest attempt at union 
in the incision which had been made in the 
abdominal walls. The intestines were very 
tympanitic. To the right of the median line 
the peritoneum of the intestines had become 
adherent to that of the abdominal parietes. 
These adhesions reached from about an inch 
above the symphisis pubis to the level of the 
umbilicus, and were longitudinal, forming a 
band about an inch in width. The intestines 
were injected, and covered with lymph. 

A very small quantity of pus was found to 
the right of the bottom of the incision. The 
omentum was found adherent to the longitu- 
dinal band described. The abdomen was re- 
markably free from fluid ; only two or three 
ounces being present in the peritoneal cavity. 
The sigmoid flexure of the colon was found 
with its opposing surfaces bound together by 
lymph, inclosing, in some spots, a very small 
quantity of purulent matter. 

Upon removal of the intestines and bringing 
the uterus into view, its volume was found to 
hei about that of the foetal head, its shape irregu- 
lar, and its fundus on the right, with the long 
axis passing thence across the abdomen to the 
left. It was partially adherent anteriorily to 
the abdominal walls. For a radius of about an 
inch and a half around the uterine incision, the 
tissues of the uterus presented a gangrenous 
appearance, without, however, the characteris- 
tic odor of gangrene. On raising the uterus up, 
no adhesions were found on the posterior re- 
gion, which was, however, covered with lymph. 
On tearing away the adhesions of the uterus to 
the abdominal walls, and cutting through the 
round ligaments, the full extent of the uterine 
opening could be distinctly seen ; there seemed 
to have been no effort whatever made at clo- 
sure. 

The linea ilio-pectinea presented no abnormal 
sharpness nor bony growths. The cause of all 
the woman's trouble was found in the shape of 
an osseous tumor situated in the concavity of 
the sacrum, involving its breadth, and extend- 
ing from about the second bone to the os coc- 
cygis. The symphysis pubis encroached some- 



what upon the antero-posterior diameter of the 
superior strait, measured three inches and three- 
quarters. The transverse measured four inches 
and one-eighth. The oblique diameters were 
in perfect proportion to these. A measurement 
from the lower margin of the symphysis pubis 
to the extremity of the sacrum gave three inches 
and three-quarters. The distance from the 
middle of the posterior face of the symphysis 
pubis to the most projecting point of the tumor 
was two inches and a quarter. This diameter 
was reduced by the walls of the uterus to less 
than two inches. 

These measurements fully demonstrate the 
propriety of the operation which was per- 
formed. 

A sub-peritoneal fibrous tumor, of the size of 
a walnut, was found on the uterus, posterior to 
the insertion of the right round ligament. One 
or two smaller ones of a similar character were 
also found. On dividing the left Fallopian tube 
near its origin, a small quantity of pus could be 
squeezed from either opening. The same result 
followed section farther down. The right Fall- 
opian tube and round ligament presented 
greater vascular injection than those of the left 
side, and section of the former gave exit to a 
considerable quantity of pus. The uterus was 
flaccid and imperfectly contracted. Upon ma- 
king a small section near the fundus, clotted 
blood escaped from the uterine sinuses. There 
was apparently no pus in them. The researches 
of Prof. Alonzo Clark have shown, however, 
that pus may sometimes be detected in these 
cases under the microscope, when to the naked 
eye none is visible. The liver was of normal 
size but had undergone fatty degeneration. The 
kidneys were also evidently fatty, though nor- 
mal in size. The heart was normal in size, 
flaccid, and free from valvular disease. A por- 
tion of its tissue was removed for microscopical 
examination. There were no adhesions in the 
pleural cavities, and the lungs were free from 
tubercles and purulent deposits. 

The pelvis of this woman is in process of 
preparation for the museum of the hospital, 

A remarkable feature of this case was the 
total absence of any attempt by nature at 
healthy reparative action. The low status of 
the vital forces found still further expression in 
the fatty degeneration of the liver and kidneys. 



CASE OF PELVIC PRESENTATION. 

An interesting and rather anomalous case 
was related at Bellevue Hospital by Dr. Elliott. 
He exhibited a dead new-born child — a girl, 
which was the largest child he had ever de- 
livered. It weighed fourteen pounds. It was 
the eighth pregnancy of the mother ; she had 
an ample pelvis, and had carried this child ten 
months before labor set in. He was called in 
consultation on account of a non-advance in 
labor. The membranes had ruptured while 



172 



MEDICAL SOCIETIES. 



Vol. V. Ko. 7 



the presentation could not yet be readied : and 
upon making an examination lie found a pelvic 
presentation, the sacrum being toward the right 
acetabulum, and the dorsum of the child to- 
ward the abdomen of the mother — the most 
frequent form of pelvic presentations. 

The efforts appeared to be powerful, and the 
delay seemed the result of overdistension of the 
uterus. The great bulk of whatever was con- 
tained in the uterus was ascertained, by exter- 
nal examination of the abdomen, to be on the 
left side. So that, assuming the existence of 
only one child in the uterus, we had the anoma- 
ly of the presentation as described, the nates 
small absolutely, the balance of the child rela- 
tively immense, and its great convexity on the 
left side! Images of course arose to the mind 
of twins, and monsters of every kind : double 
children, children with two heads, hydroce- 
phalic children, children with ascites, etc. 

He advised delay. 

On the next morning, there being no change 
and the patient's condition being good, delay 
was no longer considered advisable. The pre- 
senting part was found, on examination, to be 
just dipping into the superior strait. He there- 
fore (chloroform having been administered) in- 
troduced his right hand and pulled upon the 
anterior leg. In this way, and with the finger 
in the groin, he pulled and tugged and toiled 
with all the force he could command, without 
any advance in the way of delivery. He then 
had recourse to the blunt hook in the groin, 
and, after long and wearisome effort, succeeded 
in drawing that part of the child down to the 
vulva. The leg of that side was, by that time, 
pendulous merely by a portion of the skin. The 
child was, of course, long since dead. He then, 
by similar efforts, drew down the other side. 
The head passed without instrumental assist- 
ance. 

The child presented a very much bruised and 
battered appearance, as might be imagined, and 
certainly was of immense size. The extreme 
smallness of the nates made a very remarkable 
contrast with the great bulk of the rest of the 
child. 

In the course of his remarks upon this case, 
Dr. Elliott called attention to the rythmical 
contractions of the sphincter ani, as a diagno- 
stic element in cases of pelvic presentations. 
The existence of these contractions was indu- 
bitable proof of life in the foetus. When it was 
not to be recognized, reflex action had ceased 
and life had fled. We were thus enabled to de- 
termine at once the presentation and the fact of 
the life or death of the foetus. 

In cases demanding the use of an anaesthetic, 
he always had recourse to chloroform. It al- 
ways did its work thoroughly, and he had never 
seen any alarming symptoms resulting from its 
employment. He objected to the blunt hook, 
because the curve was alwavs too small for the 



groin, and that, on this account, it often did 
injury which might be avoided by the employ- 
ment of better-adapted means. C. 



NEW YOEK ACADEMY OF MEDICINE. 

ANNIVERSARY MEETING. 

This Association celebrated its anniversary 
on the evening of Wednesday, Oct. 7th, in the 
building of the N. Y. Historical Society, corner 
of Second avenue and Eleventh street. Dr. Gr. 

C. Buck, Vice-President, in the chair. The 
audience consisted principally of the Medical 
Faculty, their friends, and families. Quite a 
number of ladies were present. On the plat- 
form were the following gentlemen : Vice-Pre- 
sidents, Drs. Joel Foster, George Buck, and M. 

D. Van Pelt; Ex-Presidents, Drs. Valentine 
Mott, Isaac Wood, J. M. Smith, and Batchel- 
der; Trustees, Drs. Jacob Harsen, J. Anderson, 
and J. T. Hubbard ; Foreign and Domestic 
Corresponding Secretary, Dr. J. W. Green. 

The reading of the minutes was dispensed 
with, and the exercises of the evening were 
opened with a prayer by the Eev. Dr. Bethune, 
after which, the President, Dr. John Watson, 
was introduced by the chairman, and de- 
delivered' an address, which treated on scien- 
tific, philosophical, and medical subjects, with 
special reference to the traits which charac- 
terize the true physician, and the kind of train- 
ing necessary for his development as such. 

Dr. Watson began by remarking that philo- 
soj^hers and men of science were sometimes 
said to be in advance of their epoch. He said 
that of all who were deserving of such titles 
this was true to some extent, and that their 
greatness was in direct ratio to the degree to 
which it might be truthfully said they were so. 
God never made a thoroughly original and 
independent man. The whims and caprices of 
instructors were received as postulates, without 
due sifting and investigation. In every age, 
the most enlightened and fearless thinkers and 
actors had been swayed, more or less, in spite 
of their inward convictions, by the prejudices 
and superstitions of those around them — those 
infinitely their inferiors in every respect. For 
illustrations of this fact, we had only need to 
refer to the histories of Socrates, Luther, Bacon, 
and many other great men. They had all 
fallen, to a greater or less degree, from their 
high estate. The medical profession was not 
without its great and original men — would that 
she could boast of more ! 

Most men, he said, of ordinary capacity, soon 
became able to detect and diagnose disease in 
its usual phases ; but it was the part of the 



mVEMBER 17, 1860. 



MEDICAL SOCIETIES. 



173 



true pli3^sician to unravel obscure cases, pene- 
trate into the arcana of pathology, drag disease 
from its secret lurking places, and discern light, 
where to others all was darkness and obscurity. 

Such ability was less the result of logic and 
philosophy than of cultivation and practice. 
It supposed as a pre-requisite a mind tho- 
roughly imbued with the love of truth and zeal 
in its pursuit ; a mind docile and discerning ; 
habits of investigation and reflection; capabili- 
ties for rigid analysis and induction ; and a tho- 
rough knowledge and appreciation of the habits, 
language, and usual surroundings of the sick. 

No one man was endowed with the full en- 
joyment of all the desired qualities. Perfection 
was to be imagined, not beheld. 

The training of the man aiming at a complete 
education, and a position as a skillful investi- 
gator, in the higher walks of the profession, 
began, he said, where that of ordinary men 
ceased. He was by this course enabled to 
guard against error, to better appreciate the 
fruits resulting from the labors of his cotempo- 
raries, and to add to them himself. He did not 
study aimlessly or in a desultory manner ; in 
his choice of books was confined to no name or 
nation, and putting no faith in the retailers of 
other men's views, perused the originals in the 
language in which they were originally pub- 
lished. 

In his opinion, it was not necessary for the 
success of the close observer that he should 
have immense practical advantages in the way 
of hospital service, etc. Hippocrates, Scarpa, 
Sydenham, and many others of the great lumi- 
naries of the profession, had had few facilities 
of this nature. He thought single cases, well 
studied and analyzed, better calculated to ex- 
tend the powers and ripen the judgment than 
a large and desultory hospital practice. 

He dwelt upon the importance of a proper 
registration of facts and cases as leading to 
habits of close analysis ; and upon the import- 
ant generalizations sometimes resulting from 
properly recorded and digested isolated facts, 
as examplified in the inductions of Harvey and 
Jenner. Too great a multiplicity of facts in 
heterogenous array he regarded as apt to con- 
fuse the mind and blunt the acuteness of the 
judgment. 

In the study of pathology, nature, he said, 
was the experimenter and the physician the 
interpreter. 

The value often of enthusiasm and earnest- 
ness, even in a mistaken direction, he illustrated 
by reference to the lucubrations of the ancient 
Alchymists, who, in the pursuit of their ignis 
fatuus, yet contributed so much to the elemen- 
tary elaboration of our modern chemistry. 

The importance of associated labor he spoke 
of as being very great. "In union there is 
strength.'^ Frequent association, discussion, 
and interchange of views and theories with 
one's compeers and co-laborers were invaluable; 
but he was sorry to remark that in professedly 



scientific associations mere forms and ceremo- 
nies often took the place of real work. This 
was to be strongly deprecated. 

In contrasting the state of the profession in 
this country with that of it in monarchical 
countries, particularly with reference to the 
comparative advantages enjoyed here by neo- 
phytes, he spoke of our great indebtedness to 
Davy Crockett for his motto — " Be sure you're 
right, then go ahead" — now an accepted Ame- 
ricanism, and to the great principle enunciated 
by Jefferson — "All men are created free and 
equal.'' The only trouble was, that in the 
motto of Crockett, the first clause was too often 
overlooked or forgotten, and the latter only 
acted upon. When Cullen first published his 
work on Materia Medica, the Faculty of Edin- 
burgh compelled him to retract some views of 
which they did not approve. No dictation of 
that kind was submitted to here from any 
source. In America, no man of talent was 
compelled to hide his light under a bushel 
through fear of professorial frowns. The great 
latitude, in every respect, existing here for me- 
dical men of all classes and characters, was 
calculated, all things considered, to promote 
the advancement of science. 

If our schools were not equal to the best 
schools of Europe, it was not from a want of 
indigenous talent, but it was because the re- 
quirements for graduation were of too low a 
grade. He wished to urge the fact upon the 
profession. The progress of medical science 
demanded a change in reference to the require- 
ments of the schools. The grade must be 
raised. Nevertheless, any student in whom 
the will was not wanting could become an 
accomplished jDliysician. Nowhere was the 
habit of reading so general, and although the 
medical luminaries were not so numerous as in 
European countries, yet the 5orf?/ of the profes- 
sion here was better read and posted on im- 
portant points. 

In speaking of the subdivision of the 
science into special branches, in England, and 
the gradation of the men belonging to the pro- 
fession, according as they belonged to one or 
the other branch, with the results, he stated 
that upon his (Dr. Watson's) once having 
spoken to Sir Astley Cooper of M. Louis, the 
distinguished French physician, Sir Astley 
stated that he had never heard of him ! Sir 
Astley Cooper was a surgeon — M. Louis 2u phy- 
sician. The English system he thought to be a 
most pernicious one ; taking into considera- 
tion at once the advancement of science, 
the welfare of the profession generally, and the 
safety of the sick. Here we had no aristocracy 
in the profession but that of intellect. 

Some men, he said, were capable of only very 
limited development. So far might they go, 
but no farther. There was a great difference 
between a simply scientific and a truly philo- 
sophical mind. Others, again, were endowed 
with so fine an organization that for them an 



1T4 



MEDICAL SOCIETIES. 



Vol. V. Xo. 7 



almost infinite self-improvement was possible. 
They never became conscious of having reached 
the highest round in the ladder of their capa- 
bilities. In the former class was found the char- 
latan and medical mountebank, — brazen-faced, 
obtrusive, and dogmatic, — never abashed, the 
man to challenge the admiration and applause 
of the gaping throng. The man of the latter 
type, on the other hand, was never obtrusive or 
positive. Almost unconsciously to himself, he 
was possessed of energy, circumspection, and 
tenacity of purpose ; an acute insight into 
the human affections; a hopeful disposition; 
a delicate perception of propriety ; a strong 
and abiding love of truth ; and that " cha- 
rity which suffereth long, and upbraideth 
not ;'' — qualities which, when subjected to 
the mellowing influence of experience, con- 
stituted the difference between the true phy- 
pician and the quack. Men of this type always 
struggled up and made themselves felt — irre- 
pressibles, no matter what their early educa- 
tional advantages might be. In illustration of 
this, we had need only refer to the histories of 
John Hunter, Sir Astley Cooper, Ambrose 
Pare, and men of that ilk — men who had en- 
joyed but to a limited extent the advantages of 
an early literary or philosophical training, and 
whose names had become watchwords in the 
profession. 

What is called a knowledge of the world, he 
considered to be essential to the physician as to 
the man of business. The physician should not 
plod along in the beaten track, looking neither 
to the right nor left, but should always be on 
the lookout for useful hints, outside of his own 
peculiar line. He thought it not amiss for the 
physician to have a little stock of gossip on 
hand to retail for the diversion of some of his 
patients. 

In remarking upon the eccentricities of some 
great men, he related of Dupuytren, that, upon 
his once having been called on to treat a lady 
who had dislocated her shoulder, he, upon en- 
tering her chamber, surveyed her narrowly for 
a moment, and then said abruptly, "Madam, 
you have been drinking — I had it from your 
son." The lady was, of course, very much 
shocked, and fainted on the spot. This was 
just the effect Dupuytren had wished to pro- 
duce. While she was in this condition he re- 
duced the dislocation, and, upon her reviving, 
said to her, " Madam, you had been drinking 
vjater — I had this also from your son.'' He re- 
marked that such things would do once in a 
while, and for great men ; but as a general rule 
such manoeuvres, however brilliant and well 
executed, were not considered in order. In 
most instances a manner the reverse of this 
was the best. We must not treat our patients 
as bales of merchandize, but by a persuasive 
manner should endeavor to unlock the recesses 
of their hearts, and, as was our duty, acquire a 
thorough knowledge of their antipathies, hob- 
bies, emotional idiosyncrasies, etc. This was 
often most important. 



In illustration of the delicacy to which habits 
of observation and analogical reasoning might 
be carried, he referred to the ability of Cuvier, 
the celebrated naturalist, to give a minute de- 
scription of an animal of any kind, from a sim- 
ple inspection of one bone which belonged to it. 
A physician whose faculties were trained to 
anything like an approximatian to this pitch of 
acuteness could, in the elicitation of symptoms, 
and his inductions therefrom, be infinitely more 
precise and rigid than any man of not more 
than ordinary training. 

He spoke of the honor and confidence which 
were always, as a matter of course, the attri- 
butes of the high-minded physician, in regard 
to disclosures as to circumstances, habits, feel- 
ings, propensities, and religious aspirations. 
The religious views and feelings of the sick 
were always to be treated with respect, even 
though the physician himself should happen to 
be sceptical. And, on the other hand, the physi- 
cian, if religiously inclined, should never ob- 
trude censure on the sick, if they should be of 
an opposite turn of mind. 

The medical man must be careful not to 
carry an atmosphere of gloom with him wher- 
ever his duties call him. He should properly 
wear an air of seriousness, but it should go no 
farther. He should go into society to some ex- 
tent, to guard against that sombreness and mis- 
anthropy, which too often belonged to profes- 
sional men. He should not do this, however, 
with the ardor of the habitue : he might well 
afford to forego some of the pleasures of fash- 
ionable life. 

The love of gain, as a ruling passion, he 
strongly inveighed against. The young prac- 
titioner could not be too guarded on this point. 
When this grovelling passion supplanted the 
desire for usefulness, no matter what his talents 
and education, the physician became reduced to 
the level of the shopkeeper. He continued with 
an enumeration of the various things to be 
taken into account in making charges. 

In regard to complaints of want of success, 
appreciation, etc., he quoted and endorsed the 
saying of Dr. Johnson, " I hate a complainer.'' 
The most complaints came from those who 
least merited success. They who whined most 
deserved least. 

He quoted the answer given by Daniel Web- 
ster to a young lawyer who inquired of him 
whether the profession of law was not already 
too crowded. " There is plenty of room up 
stairs." It might be well and fully applied to 
the medical profession. There was always 
room in the front ranks. 

At the conclusion of Dr. Watson's address, 
Prof. Smith, of the College of Physicians and 
Surgeons, moved that a vote of thanks be pre- 
sented to Dr. Watson, and that he should be 
requested to furnish a copy to a committee for 
publication. He stated that the person who had 
been selected to deliver the address on the oc- 
casion had been prevented by sickness; that 



KOVEMBER IT, 1860. 



PERISCOPE. 



175 



the address of Dr. Watson had been kindly 
volunteered, and written on very short notice. 
He complimented the Doctor very highly on 
his effort. 

Dr. Stevens followed. He seconded the mo- 
tion of Dr. Smith, and expressed the hope that 
the sentiments pervading the address of Dr. 
Watson were those of the Academy at large. 

The motion of Dr. Smith having been car- 
ried unanimously, the audience was invited to 
inspect the library and picture gallery of the 
society in whose building they were assembled. 

The meeting then adjourned. 

The invitation extended to the audience was 
by no means an empty one. The picture gal- 
lery is, undoubtedly a very fair one, and the 
library contains more than forty thousand 
volumes. c. 



EDITORIAL DEPAnrmEHT, 

PERISCOPE. 

POISONING BY OPIUM AND STRYCHNIA. 

In the November number of the Chicago 
Medical Journal, Dr. J. S. Pashley, of Osceola, 
111., reports a case of suicide by opium and 
strychnine, which is interesting, as showing the 
effect of these substances when taken conjointly. 

The subject was a man, 29 years of age, in 
ordinary health for some time previous, though 
mentally depressed by pecuniary embarrass- 
ment and disabled from a paralytic attack 
which occurred five years previously, and was 
repeated three years ago, leaving the left side 
of the body entirely useless. 

To commit suicide, he took three grains of 
strychnine, one drachm of opium, with an in- 
definite quantity of quinine, at about 10 o'clock 
on the evening of September 1. 

When seen by Dr. Pashley, at 10 o'clock 
A. M., September 2, he had been twelve hours 
under the operation of this dose, resolutely de- 
nying any unusual feelings, or sensations, in 
spite of his strange appearance and actions. 

There was extreme cerebral excitement ; con- 
junctiva highly injected; eyes suffused with 
tears — pupils contracted ; the whole face of a 
deep-red color ; mouth and lips dry and clammy ; 
tongue tremulous and covered with a white, 
brownish fur ; voice dry, husky, and incoherent 
in expressions ; whole surface hot with profuse 
perspiration ; l3ody and limbs in violent tremor, 
and at intervals spasmodic action of all the 
muscles, alternating with comparative quiet 
and drowsiness, from which he was easily 
roused. Pulse 120, full and forcible; carotid 
pulsating violently ; the respiration labored, 
and the air of the room redolent of opium ; 
complained only of feeling "queer." 

Administered zinci sulph. in full emetic doses 
14 



in strong coffee, by which opium was freely 
ejected. 

At 11 o'clock the patient was more quiet, and 
force of the heart's action somewhat dimi- 
nished. He now required frequent rousing, but 
when roused would start violently and remain 
delirious for some minutes. Gave Croton oil, 
gtt. iii, w^ith camph. gr. viii ; applied bladder 
of cold water to th*e head ; perspiration still 
very profuse. 

1 P. M. Profound stupor suddenly super- 
vened, from which no effort could rouse him. 
Cold water was applied to the spine and occiput 
ad libitum, followed by violent friction, shakings, 
etc., but of no avail. Muscular system alter- 
nately relaxed and rigid ; deglutition impossi- 
ble ; pupils contracted still more ; breathing 
stertorous ; surface dry and cooler ; pulse ra- 
pi^ly sinking ; heart's action very irregular. 

8 P. M. Superficial vessels of head and neck 
suddenly engorged ; surface became livid ; pul- 
sations at the wrist not readily observable, and 
those of the heart intermittent. The blood 
seemed to leave the heart en masse and rush to 
the head during the interval of two or three 
beats, alternating thus for about half an hour, 
when more regular and rapid action of the 
heart followed. 

4 P.M. Comparatively quiet; having pre- 
viously applied sinapisms to spine, and blisters 
to inside of the thighs, an electro-magnetic bat- 
tery of considerable power was used, with the 
effect to stimulate muscular and nerve force, 
and by keeping up the heart's action maintain- 
ing the normal heat of the body to the last mo- 
ment of life. 

September 3d, 8 A, M. Continued as before, 
only that, on violently shaking, the jaws and 
eyelids would close, being generally more sus- 
ceptible to electric force. Respiration sighing ; 
some symptoms of peristaltic action in bowels. 
Administered enema of Croton oil, chlor. sodse 
and lard, with warm water, but which was 
speedily returned. 

1 P. M. Succeeded in giving Croton oil, gtt. 
ij, and a small quantity of camphor in water ; 
the same being slowly but efi'ectually swal- 
lowed. 

2.15 P. M. While standing by the patient, 
and somewhat cheered by the apparently-gra- 
dual return of sensibility for the past four or 
six hours, the pupils suddenly dilated, followed 
by a slight movement of the body, and death 
closed the scene. 

A hasty examination of the brain was per- 
mitted, nineteen hours after death, in presence 
of Dr. E. R. Boardman, and J. Gr. Boardman, 
medical student. 

Found longitudinal sinus and all the super- 
ficial vessels unusually engorged, more particu- 
larly on the right side. The arachnoid mem- 
brane of that side presented a remarkable con- 
trast to its opposite, being highly injected, and 
consequently very dark in color. 

The cavitv of the right ventricle was greatly 



176 



EDITOEIAL. 



Vol. V. No. 7 



enlarged as compared with its fellov/, and its 
walls much miore readily broken down. All 
the brain matter on the right side was unusu- 
ally soft, and could with difficulty be handled. 

There seems to have been, as Dr. Pashley 
justly remarks, a struggle for the predominance 
in effect of the strychnia and opium, the nar- 
cotic tinally prevailing, so that, after the first 
thirteen hours, he remained in the most pro- 
found stupor for twenty-five hours, making in 
all thirty-eight hours before the fatal termina- 
tion. 

It does not appear precisely, from the report 
of the case, whether the muscles of the para- 
lyzed side partook in the rigidity and spasmo- 
dic miovements which were observed, and if so, 
whether the rigidity and spasms were as well 
marked as on the side opposite. It is ip inte- 
resting question, whether the softened condition 
of the brain and the paralyzed state may not 
have lessened the liability to become affected 
by the strychnia, as much as the opiumi ; and 
again, whether the large amount of quinia ac- 
companying both may not have acted in the 
same manner. 



ABDOMINAL TUBERCULOSIS. 

In a clinical lecture on tubercular disease of 
the mesentery of children, delivered at the St. 
Eugenia Hospital, at Paris, and published in 
the Jour, fur Kinderlc. Dr. Bouchut makes 
some remarks on the complications of this 
•disease. 

One of the principal complications is caused 
by the ulcerations to which the tubercular de- 
posit leads. Copious bloody discharges, or 
fsecal evacuations, striped with blood, are ob- 
served when this takes place. In consequence 
of perforations of the intestinal canal we may 
have peritonitis, which may take a rapid or 
slow course, according to whether the perfora- 
tion communicates with the peritoneal cavity 
•or terminates in adhesion of the perforated gut 
to the peritoneum. If the peritonitis progresses 
slowly, it is accompanied with much pain, obsti- 
nate vomiting ; sometimes, however, only a 
painful tension or a dull aching is present, and 
occasionally the peritonitis progresses so ob- 
scurely, or rather unobserved, that dropsical 
effusion takes place before we have been aware 
of -anything else, and then the dropsy, for 
which no other cause can be found, is the only 
characteristic symptom of abdominal tubercu- 
losis. 

Another complication is the debility and 
anemia consequent upon the dyspepsia and 
fever, resulting in general oedema and dropsy, 
which soon terminate in death. In these 
cases albuminuria is present occasionally, but, 
generally, there is no essential change in the 
constituents of the urine. 

In reference to diagnosis, entero-mesenteric 
tuberculosis cannot, at the commencement of 



the local affection, be easily recognized. As it 
often commences in a latent manner, not unfre- 
quently the symptoms of an acute or chronic 
enteritis first occur, the nature and cause of 
which cannot readily be determined. Only 
when the disease has further progressed, the 
alternating constipation and diarrhoea, the tym- 
panitis, dropsical accumulations, knotty eleva- 
tions of the mesentery, and the accompanying 
formation of tubercules in the lungs, or in 
other organs, remove all doubt. 

Entero-mesenteric tuberculosis can be con- 
founded only with rhachitis, f^cal accumula- 
tion in the intestines, and simple chronic en- 
teritis. In rachitis we have frequently very 
considerable tumefaction of the belly, and some- 
times diarrhoea ; but the softness of the bones, 
the remaining open of the fontanelles, the cur- 
vatures of the spine in the lumbar region, and 1 
the thickening of the spongy portions of the 
long bones are sufiicient characteristics. 

Eegarding fascal accumulations, or so-called 
scybala, the seat of these masses, throws light ^ 
upon the case. The tubercular mesenteric 
glands are felt in the centre of the abdomen 
and belov/ the umbilicus, while the scybala 
always have their seat at the side and espe- 
cially at the sigmoid flexure of the colon. Fi- 
nally, simple chronic enteritis which, with its 
accompanying emaciation and diarrhoea, most 
closely simulates abdominal tuberculosis, is 
distinguished from it by not continuing so long, 
by not producing as much tumefaction of the 
abdomen, and being never accompanied by 
hardened tumors or swellings in the mesentery. 



EPITHELIAL CANCER OF THE TONGUE. 

We have in the last number given a resume 
of Mr. Hutchinson's clinical reports on Epithe- 
lial Cancer of the Lip, published in the London 
Medical Times and Gazette, and avail ourselves 
to-day to give a similar abstract of his report 
on nineteen cases of epithelial cancer of the 
tongue. 

The report comprises nineteen cases, in nearly 
all which operations had been performed. Can- 
cer of the tongue is, however, a form of the dis- 
ease which in a majority of instances does not 
permit of operative interference, since, very com 
monly, the patients do not come under hospital 
care until the disease is too far advanced. Thus, 
in all probability, during the period to which 
the present report refers, at least four times as 
many cases of cancer of the tongue have been 
under care at the different metropolitan hos- 
pitals. 

Of the 19 cases, 12 were males, 6 females, and 
in one the sex is not given. The average age 
was 54 years, the extremes being 32 and 78. 
In two cases only palliative treatment was 
adopted, the disease having too far advanced. 
In one of these cases the patient, an old woman 



November 17, 1860. 



EDITOEIAL. 



177 



of 78, died of the disease within five months of its 
commencement, and in the other it is not proba- 
ble that his life was prolonged beyond six or 
seven months. 

Of the cases in which operations were per- 
formed, in one the disease had existed 3 months, 
in one 4 months, in one 8 months, in one a year, 
in one 18 months, one 5 months, and in a sixth 
it was stated that a hard pimple had first made 
its appearance two years before. In six cases 
no details are given as to the duration of the 
disease. These facts indicate in a clear man- 
ner the acute character of cancer of the tongue. 
Cancer of this organ was formerly considered 
scirrhous ; but it is now well known that its 
histological character differs in no respect from 
those of epithelial cancer of other mucous sur- 
faces. It also conforms to the habits of the 
latter disease in that, while it constantly causes 
enlargement of the lymphatic glands, it does 
not, as a rule, occasion deposits in the internal 
organs. The rapidity of its progress, therefore, 
as compared with that of epithelial cancer of the 
lip and of the skin generally, must be explained 
by reference to the succulent structure of the 
organ and the facilities thereby offered for 
growth by infiltration, and for rapidity of ab- 
sorption, and by the difficulty of affecting a free 
removal of the original disease by operation. 
The lymphatic glands, which enlarge seconda- 
rily in cancer of the tongue, are deep-seated, 
and not usually susceptible of removal. 

Of the 17 cases in which operations were per- 
formed, the disease was removed by the knife 
in 8, by the ligature in 5, and by the ecraseur 
in 4. Of these three died from the immediate 
effects of the operation. In ten the wound 
healed and the patient left the hospital, while 
in four others the disease recurred either before 
the wound was healed or very shortly after. 
Two of the fatal cases died of pysemia, one six 
the other seven weeks after the operation. 



HEYIEWS AND BOOK NOTICES. 

Electro-Physiology and Electro-Therapeu- 
tics : By Alfred C. Garratt, M. D. Boston : 
Ticknor & Fields, 1860. 

We have attentively perused this work, and 
have no hesitation in commending it as the 
result of long, laborious, patient, and careful 
study of the whole subject of medical electri- 
city. It is in great measure a compendium of 
the results obtained in this department by the 
investigations of such men as Galvani, Volta, 
Humboldt, Matteuci, De la Eive, Dubois-Eay- 
mond, Faraday, and Duchenne, bringing the 
subject down to the present day. On this ac- 
count, it merits a place in the library of every 
physician who desires to keep himself posted 



up in the knowledge of his jorofession, and to 
be duly acquainted with the use of a powerful 
agent (when rightly employed) in the treat- 
ment of disease. Dr. Garratt tells us he has 
written this book mainly for the use of stu- 
dents, and has accordingly introduced many 
wood cuts, (such as those of the spinal column, 
etc.,) and much matter that might well be dis- 
pensed with, or find their place more appro- 
priately in a treatise on Anatomy. The young 
student will find in it a great deal that is above 
his comprehension ; but those who are more 
advanced, as well as young practitioners, with 
some leisure time on their hands, vv^ill find it 
amply to repay them for a close investigation. 
The chapters on atmospheric electricity are to 
us the most unsatisfactory ; they have evidently 
been written ten years since, and need consider- 
able pruning and revision ; this is unfortunate, 
as they involve the subject of the electrical 
origin, or otherwise, of epidemics. This, how- 
ever, is the only fault we have to find with the 
book, if we except a magnanimous indifference 
to the correct spelling of some proper names, 
which is all the more remarkable in a book 
otherwise so well gotten up. 



THE MEDICAL AND SURGICAL EXPORTER. 

PHILADELPHIA, SATURDAY, NOYEMBER 17, 1860. 

SCIENCE COSMOPOLITAN. 

In the whirlpool of exciting times like these, 
when old thrones are tottering and falling into 
the dust, when nationalities are, after centuries of 
sleep, awaking and battling against oppression 
by other nationalities, and when individuality 
is asserting its rights all over the world, when 
the dreams of the cosmopolitan, the reformer, 
the humanitarian, all seem to be knocked into 
one confused heap, 

'* rudis indigestaque moles," 
out of which nobody knows what will come, it 
is a consoling thought, nay a sublime consola- 
tion, that there is one thing, at least, which is 
not affected by race, soil, climate, winds or 
waves — one department of human affairs not in- 
fluenced by the tendencies of national or perso- 
nal individualism. 

Science is universal ! Science is not bound 
down by narrow-minded prejudices ! It encir- 
cles in its embrace the civilized world ; in one 
word, it is cosmopolitan ! 

Such was the miserable delusion with which 
we had flattered ourselves. We had imagined 



178 



EDITOEIAL. 



Vol. V. No. 7. 



that when Humboldt traveled in South America 
it was, perchance, the same spirit of scientific 
investigation leading him to ascend the Chimbo- 
razo, which led Kane to plant the stars and 
stripes upon the ice-fields in the polar circle, 
and we foolishly thought that when Harvey 
demonstrated the circulation of the blood, he 
had no idea of taking out a copyright for his 
discovery in favor of his immediate descend- 
ants, or the inhabitants of Great Britain gene- 
rally. 

Yet we were mistaken, most foolishly mis- 
taken ! Under the shame of ignorance, how- 
ever, under which our poor mortal frame groans, 
we have yet the consolation that we were not 
alone, but that we have had fellow-fools from 
the commencement of the time when the name 
of science was first breathed, up to this date. 

Stop ! Not to this date. Only up to August 
first, one thousand eight hundred and sixty, or 
thereabouts, when the August number of the 
Medical Journal of North Carolina, issued bi- 
monthly, commenced, at page five hundred and 
nineteen and finished at five hundred and twen- 
ty-two, an editorial article which proves as 
plainly as Don Quixote proved to Sancho Panza 
the logic of his Dulcinean adventures, not only 
that science is woi! cosmopolitan, but that it must 
speedily, at once, and most imperatively, be 
''fenced in.'' 

But to speak seriously, if the excitement of 
political times must drive men whom we expect 
to be guided by sober sense, so far as to discuss 
politics a la Billingsgate in journals that pretend 
to be devoted to science, we hope that it will be 
done, at least, without economizing the truth, which 
is entirely inexcusable. 

We acknowledge no different sections in these 
United States, nor do we stand up for the pre- 
eminence of any centre — real or would-be — of 
medical education ; but, when the MedicalJour- 
nal of North Carolina says that it is " fashion- 
able in northern cities to ignore the claims to 
respectability of the southern student at all 
times, and to treat him more as an outcast than 
as a gentleman whenever an occasion presents 
itself," that journal knows that it is balancing 



the truth on the point of a pin, only to show its 
expertness and to bring grist to the mill, in 
which it plays the part of the miller. 

The Journal talks of the man " who is de- 
spised because he is a student, and hated on 
account of his southern blood," and paints in 
doleful language the " hard^,time " which he 
must have, under such circumstances, to prose- 
cute his studies. Doleful, indeed! only that, 
like the man of the moon, children only can 
see him. 

It does not, of course, enter into our province 
to quarrel with the Medical Journal of North 
Carolina, if it succeeds, by every possible honor- 
able means to draw students to the particular 
interests which it represents ; but protest we 
must when it attempts to do so by means for 
which even ignorance can be no excuse. And, 
before all, in a spirit of fellow-feeling for our 
cotemporary, we would suggest to it not to dis- 
prove by the spirit of its words what it endea- 
vors to prove by their literal meaning. 

When, for instance, it says " that no man 
can study to any advantage whose mind is dis- 
tracted by excited passions, or diverted from the 
legitimate object of its pursuit by other and 
more absorbing matters," the very article in 
which that sentence occurs is so full of excite- 
ment, passion, and of matters not belong- 
ing to science, that any one who reads it, must 
suppose it intended to keep students at a re- 
spectful distance from any point within its ra- 
dius ; and yet we all know (and the Journal will 
scarcely be willing to deny it, we suppose) that 
the article referred to was especially written to 
attract students instead of repelling them. 

It is to be hoped that those who represent 
medical schools in the medical press through- 
out the country, will begin to be honest amongst 
themselves and honest to the profession. It is 
high time, if they do not wish to see themselves 
swamped by the rising tide of a sound, healthy 
medical revival, the forebodings of which can 
be traced everywhere. No one has any objec- 
tion against rivalry — nay, it is even necessary ; 
it will stimulate to progress and endeavors to 
excel. But let that rivalry be an honorable 
one ; let it consist in improving the facilities for 



A 



November 17, 1860. 



CORRESPONDENCE. 



179 



learning and excelling the rival, but not in ap- 
pealing to angry passions and making state- 
ments wliicii cannot be borne out by truth. 



SPIRIT OF THE MEDICAL PRESS. 
The September number of the Atlanta (Geo.) 
Medical and Surgical Journal comes to us with 
the Valedictory of Drs. Logan and "W. F. West- 
moreland, its late editors. For five years our 
editorial intercourse with these gentlemen has 
been most pleasant, agreeable, and profita- 
ble, and we part with them with sincere 
regret. We are sorry to learn that their five 
years' labor has been one merely of love. Dr. 
J. Gr. Westmoreland assumes the editor- and pro- 
prietorship in a well-conceived salutatory. The 
Atlanta has been- one of our sterling journals, 
and, from what we know of the abilities of the 
new editor, we feel satisfied that it will not take 
a step backward. 

The leading editorial of the Louisville Monthly 
Medical News hardly, we think, comports with 
the dignity that should characterize a work de- 
voted to science. It is nothing more than a 
witty novelette, the hero being a quack and an 
arrant hypocrite. Its flings at professors of re- 
ligion, by being so sweeping, are out of taste, 
to say the least, and tantamount to a con- 
demnation of all who connect themselves with 
churches. The News might have made its 
point in a much less objectionable and more 
dignified manner. 

The Lancet comments on the alacrity which 
governments manifest in detecting adulterations 
designed as frauds on the revenue, as contrasted 
with their indilBference to those which are per- 
petrated at the expense of the consumer, as of 
food and drink, and, it might have added, medi- 
cines. It claims that we should have adequate 
security that the bread, which is our daily food, 
the milk, upon which the infant population is 
reared, shall not be so tampered with, empoi- 
soned, or impoverished, as to be rendered inca- 
pable of conversion into living bone and mus- 
cle. It looks to the Act for Preventing Adulte- 
ration of Articles of Food and Drink — itself an 
adulterated article, in consequence of the oppo- 
sition it met in Parliament — to aid in putting a 
I stop to the evils resulting from the adulteration 
I of articles of food and drink. In our country, 
this is an almost totally neglected field for the 
restrictive exercise of legal enactments, except 
as regards the importation of adulterated drugs. 
In our chief commercial cities, drug inspectors 



are appointed by government — men, however, 
who are too often more given to politics than to 
the materia medica — to prevent the importation 
of adulterated drugs, though there is no check 
on home adulteration by the "grinders.'^ The 
Legislatures of most, if not all, of our States 
contain some medical men. They could scarcely 
serve the public better than by urging the pas- 
sage of laws against the adulteration of food, 
drink, and medicines. 

The Lancet recommends the prohibition, by 
statute, of those horrible dances and tours de 
force on a tight-rope, which produce some ex- 
citement to the public and gain to the perform- 
ers, at a risk of life, which has just received 
an illustration in France in the case of two pa- 
tients, recently received into a Parisian hospital, 
severely, if not fatally, injured by falls while 
performing a daring feat on the tight-rope at 
an elevation of ninety yards from the ground. 
There are fools of the same kind in this coun- 
try, who should be brought under the whole- 
some restraints of legal enactments. 



We commence this week the publication of 
Reports of Medical Societies, and Hospital 
AND Clinical Records of New York, which 
hereafter will appear regularly, in their proper 
places, under the signature of " C.,'' whom our 
readers will find to be a de'il o' a " chiel 
amang them takin' notes.'' 



EUROPEAN CORRESPONDENCE. 

London, Oct 15th, 18G0. 
Editors of Medical and Surgical Reporter : 

Gentlemen: — The day before yesterday I 
attended St. Bartholemew's Hospital on the 
occasion of the weekly clinic which is held 
there. I was in hopes of seeing some of the 
distinguished surgeons of London, and my ex- 
pectation was not disappointed. 

There were many more students in the room 
than I had seen when I visited the hospital 
before. Then there had only been 20 or 30 
present, while on this occasion the room was 
crowded by perhaps 100. 

The first operation which I saw performed 
was by Mr. Lawrence. It was on a young girl, 
apparently about 18 years of age, with a very 
large tumor of the leg, which had begun about 
seven months before. Very few remarks were 



180 



COERESPONDEl^CE. 



Vol. V. No. 



made by the operator, and those which were 
made were in an almost inaudible tone of voice. 

Before the operation I understood him to say- 
that he was undecided as to whether he ought 
to consider it scrofulous or malignant ; this 
was all that I could understand of all that he 
said. 

After the administration of chloroform, in- 
cisions were made in a place where the skin 
seemed to be on the point of ulcerating, to ex- 
amine the nature of the tumor, and by pres- 
sure around them a cheesy matter was forced 
out. 

The limb was then taken off above the knee 
by the circular operation, a retractor being 
used to draw back and protect the muscles 
during the sawing of the bone. 

The patients are brought into and carried out 
of the operating room on a litter without any 
mattress, and a couple of straps are buckled 
over them to retain them with the more cer- 
tainty. 

This poor girl appeared to have been so much 
exhausted by the suffering which she had en- 
dured that she was perfectly helpless, and when 
carried made no effort even to raise her head ; 
she was very pale, and I fancied I saw indica- 
tions of the cancerous cachexia. 

An examination was made of the amputated 
leg ; but I was unable to obtain either a view 
of the tumor or a single word of the observa- 
tions made about it. 

The next operation was performed by Mr. 
Stanley, assisted by Mr. Paget. It was the 
amputation of a cancerous breast in an elderly 
woman. The tumor was large, and a well- 
marked case of hard cancer. 

The last case was the removal of a deep- 
seated, apparently fatty tumour, from the region 
of the femoral artery, just below Poupart's liga- 
ment. The tumor was small, and I could not 
but admire the powers of diagnosis which en- 
abled its nature to be recognized. The opera- 
tion was performed by Mr. Skey. All three of 
the operators were gray-haired gentlemen, par- 
tially bald, and rather short. Mr. Paget, on 
the contrary, was much younger, apparently, 
and rather tall. 

St. Bartholemew's contains 650 beds. It was 
founded A. D. 1102. Harvey lectured there on 
the circulation of the blood in 1619. 

This morning I visited the Museum of the 
College of Surgeons in Lincoln's Inn Fields. 
It is decidedly the largest I have yet seen, fill- 
ing three large rooms, one of them very long, 
and all three having two galleries surrounding 
them. There was a very full and complete 
catalogue. The collection appeared to be par- 
ticularly rich in comparative anatomy and in 
craniology. 

One remarkable specimen was that of a 
mummy, made in the last century, of the wife 
of a London citizen. An advertisement, cut 
from a newspaper of that time, was pinned close 
to it, in which the husband proclaims that he 



will not exhibit his wife's embalmed body to 
any one who is not introduced by a friend, and 
even then only at certain specified times. 

From the short time which I spent in the 
Museum, anything like a detailed description 
is, of course, impossible. When I return to 
London from the Continent, I hope to be enabled 
to visit it again, and spend more time there. 

In my next letter I shall probably give you a 
sketch of a lecture delivered in a Paris hospital. 
Very truly^ yours, 

M. D, Abroad. 



MEDICAL societies IN NEW YORK. 

New York, Nov. 13, 1860. 

Messrs. Editors : — A movement is under way 
to establish a new medical society. Part of the 
programme is " to be liberal towards young men, 
to encourage real worth, and to aid in their ad- 
vancement — scientific and also in practice — 
those that want to be * workers ' in medicine 
and have it in them.^' Don't criticize the syn- 
tax of the quotation, for it was spoken collo- 
quially and off-handedly by one of the prime 
movers, and indeed sounded well in conjunction 
with the rest of a very enthusiastic announce- 
ment of the plan, character, objects, and capa- 
bilities of the proposed society. A leading idea, 
in addition to the mutual scientific and social 
improvement arising from all well-conducted 
societies, seems to be the establishing and en- 
forcing on its members of a higher standard 
of professional ethics in practice than at present 
in vogue in Grotham. This is certainly very 
laudable, and its accomplishment a consumma- 
tion devoutly to be wished ; but I must ask you 
to suspend final judgment awhile. 

There are among us seven or eight medical 
societies. 

By far the most interesting discussion at the 
Academy of Medicine for a long time was a re- 
cent one on Pessaries. We had, on that occa- 
sion, the pleasure of hearing Dr. J. Marion 
Sims speak for the first time, though he has 
been a member of the Academy for several 
years. Dr. Gardner expressed his disapproba- 
tion of all kinds of pessaries in toto, and under 
all circumstances ; and, though this gentleman 
went to extremes and in so far erred, he had, in 
my opinion, the best side..of the argument. 

The New York Pathological Society is an ac- 
tive and, to its members, valuable society, espe- 
cially under its present able officers. 

The jSTew York Medico-Chirurgical College, 
though at first looked upon as " not exactly 
right,'' has become, through the untiring exer- 
tions of its working members (and it is fast rid- 
ding itself of other members) a valuable so- 
ciety. It is a pity that it has no abiding, 
dwelling place, for it is a peripatetic society, 
getting board and lodging in turns at the houses 
of its married members. The privacy of its 



November IT, 1860. 



COERESPOXDENCE. 



181 



meetings Las, as yet, prevented its exerting as 
much influence as it otherwise might. At present 
its existence, indeed, is but very little known ; its 
name, constitution, and by-laws are, however, 
undergoing revision, (I have been told by one 
of the members, ) and it requires but few changes 
to open for it a career of great and permanent 
usefulness in advancing scientific medicine. 

The jSTew York County Medical Society exists 
but in name, and doesn't deserve that. Its 
only meetings are its " anniversaries, '' and the 
following is an example of a farce of that kind. 
Among the Special Notices in the Medical Times 
of last Saturday, w^as seen in caps, small caps, 
and italics : — 

"New York County Medical Society. — The 
Anniversary Meeting of the New York County 
Medical Society, will be held at the College of 
Physicians and Surgeons, on Monday evening, 
November 12th, at 6 o'clock. Bv order. 

"0. White, %LJ).,PresH. 

"H. S. Downs, M. D., Secretary J' 
The number of member is nearly 500; con- 
vened at six o'clock ; fifteen a quorum, to 
gQi which those present went into the street to 
pick up some members, and for want of which 
quorum the Society was not called to order 
until half-past 7 o'clock, at which time a Doc- 
tor living across the w^ay w^as at last prevailed 
upon to lend the anniversary meeting, at which, 
too, new officers are to be elected for the ensu- 
ing year, the indispensable value of his gracious 
presence, and he was welcomed and applauded 
by hand-shaking and feet-stampings as the fif- 
teenth man. 

Order of Exercises. — Eeading of the minutes 
of last year's meeting, (an exact counterpart of 
the present minutes adopted.) Eeading of the 
minutes of the Comitia Minora, (whose business 
it is to make believe that the cadaver is still 
alive, for the purpose hereinafter mentioned.) 
No report of Treasurer, (Treasurer absent.) No 
report of Committees. No new members pro- 
posed or to be ballotted on. No communica- 
tions received. No remarks by any member. 
Election of President and Vice-President. Ee- 
election of Secretaries and Treasurer. Election 
of Censors and Comitia Minora " with full 
power." Appointment of a number of Com- 
mittees, such as one on Meteorology, one on 
Disease, one on Epidemics, one on Hygiene, 
etc., etc., (none of whom is ever expected to do 
anything.) Adoption of a resolution to prepare 
a list of deceased members to be presented to 
the State Medical Society. Adoption of a reso- 
lution to complain of the State Medical Society 
for ignoring the existence of this Society, as it 
has not sent any copies of its Transactions for 
two years, and also omitted to name the officers 
of this Society in its "List of Officers of County 
Medical Societies in the State of New York." 
(A voice was for "secession.") 

Adjournment at 8 o'clock precisely. 

The only object of the whole farce seems to 



be the preservation of the privilege of the 
" Comitia Minora" to send delegates in the 
name of the N. Y. County Medical Society to 
the various medical meetings in the land ; thus 
there were sent thirty delegates to the American 
Medical Association, etc. Whether this engineer- 
ing is to be allowed to continue, and the rights of 
such delegations confirmed, it is not for your 
correspondent to determine. 

The Medical Union, as well as the other two 
remaining Societies have but a limited number 
of members ; and though very good, as far as 
they go, cannot make themselves felt in the 
Profession ; so, you see, we really have no So- 
ciety or Association that at present represents 
anything like the Profession of New York. 
While there is, therefore, room and chance for 
a Standard Society in Grotham, it is, as yet, 
more than doubtful that the one proposed will 
supply the desideratum. 

The persistent efibrts that have been made 
here for a week past to get up a stampede of 
the Southern students, have not, I am happy to 
say, resulted in an abduction, but ended in re- 
solutions deferring action. 

Yours trulv, Gothamite. 



A NOXDESCRIPT; TETANUS IN A CHILD FROM A 

stone impacted in the ureter. 

Messrs. Editors: 

I was called October 30th to see a child, nine 
months old, suffering with cholera infantum. 
Found the child much weakened by the exces- 
sive discharges and vomiting. These were re- 
strained through the day and night by small 
doses of elixir vitriol. On my return next morn- 
ing found it insensible ; tonic carpo-pedal spasm, 
and with opisthotonic contraction. These 
symptoms, with the exception of the stupor, 
were relieved in three hours by the free use of 
cold baths and quinine. Leaving it for an hour, at 
2 P. M. I found a new set of symptoms had 
been ushered in. The pulse and skin were 
normal ; but there was exceeding difficulty in 
the respiration, with spasmodic action of the 
larynx. Suddenly there w-as a gasp, and respi- > 
ration ceased. For forty seconds the pulse beat 
steadily along, when it w^avered, and fearing 
the cessation of the heart's action, I applied my 
lips to those of the child, and closing its nos- 
trils, forced the air gently into its lungs, then 
compressing the ribs, it gasped, and after seve- 
ral insufflations, respiration was restored. Nine 
times in the ensuing four hours it was necessary 
to repeat this process, after which the breath- 
ing became regular. The stupor continued 
through the night ; pulse, skin, and respiration. 
normal till 8 A. M., when instantaneously the 
heart's action ceased, and with a few gasps all 
was over. We have the cause in the irritation 
of the bowels ; the explanation of its develop- 



182 



NEWS AND MISCELLANY. 



Vol. V. No. 



ment and consecutive action is a matter not so 
readily solved. 

I recently assisted a brother physician in the 
post mortem of an infant, sixteen months old. 
It had been sick two weeks, and was seemingly 
getting well, when tetanus supervened, and it 
died in eighteen hours. The inner portion of 
the left kidney had suppurated freely, and was 
discharging through the ureter. The cause of 
the tetanus was revealed in the right kidney, a 
stone, phosphatic, weighing two grains, had be- 
come impacted at the origin of the ureter, too 
large to be passed. We also removed two 
smaller stones from the same kidney. We had 
every reason to believe that the child would 
have survived the extensive suppuration in the 
left kidney. I doubt whether this case can be 
paralleled. A correct diagnosis was, of course, 
impossible, from the tender age. Truly our 
best discriminative efforts often prove to be 
fallacies. The case, however, will be reported 
in full. I merely desire to call your personal 
attention to it as a rarity. 

Edward H. Sholl. 

Warsaw, Ala., Nov. Sth, 1860. 



A STUDENT S COMPLAINT. 

Editors Medical and Surgical Heporter : 

Will you allow a student a space in the Ee- 
PORTER to make a few suggestions to his fellow- 
students in regard to clinics ? 

I am a great friend and admirer of so-called 
promenade concerts and have often enjoyed them. 
But of all things in the way of promenading, I 
hate promenade cliniques, which it seems the en- 
deavor of some few of my fellow-students to 
establish. It is most annoying, when one hap- 
pens to sit not far from the door, to lose the words 
of the lecturer, his questions, and the answers 
of the patient, by the constant ingress and eg- 
ress of a few stragglers, who always appear 
to be '' on the wing.-"^ These gentlemen, who, 
of course, can derive no earthly benefit from 
such perambulatory attendance, are, besides, in 
the habit of colloquial exercise, which may add 
very much to their interest, but is scarcely in 
tempo with the rest of the performance. 

Could not something be done to abolish this 
evil ? Yours, 

Studeosus. 

Philadelphia, Nov. l^th, 1860. 



The MEDICAL career is so admirable when 
divested of all cupidity, it brings so much into 
play the better feelings of our nature, that it 
often ends by being a virtue after commencing 
as a profession. — Lamariine. 



A SMALL portion of London is said to be 
crowded to the density of 243,000 inhabitants 
to the square mile. 



NEWS AND MISCELLANY. 



A Ridiculous Mistake in Diagnosis. — We placed 
in an upper set of artificial teeth for a lady 
patient about one year since, but, on account of 
the shrinking of the gums it became necessary 
to refit the plate about four weeks ago. We 
expected to retain the case in our hands about 
two days. The teeth were left us in the morn- 
ing about eight o'clock, to be finished the next 
day by five, but, to our surprise, at ten, the 
next day, a lady called to ascertain if the teeth 
could not be finished before five, as the patient 
had been taken very ill indeed early that morn- 
ing, yv'iih paralysis of the lower jaw and tongue, 
and it gave the face such a ghastly look that 
they wished the teeth as soon as possible to 
place in the mouth before she would die, and 
they did not think she would live until night. 
The teeth were finished by one o'clock, and 
dispatched at once to the patient by the hands 
of an assistant, but the patient was so very ill 
that the assistant could not be permitted to see 
her, so he returned with the teeth. But the 
next morning a little girl called for the teeth, 
with the cheerful intelligence that the patient 
had entirely recovered; that instead of it hav- 
ing h^QXi paralysis, that it was dislocation of the 
loiver jaw from incautiously yawning ; but the 
mistake was not discovered until a second 
doctor was called in, and the patient had taken 
the usual remedies for paralysis, together with 
having the nape of the neck well scarified and 
six cups applied. — Dr. White — Dental Cosmos. 

The above reminds us of a somewhat similar 
case that occurred in this city a few years ago, 
and was related to us by the late Dr. Janney. 
A gentleman while yawning, as he awoke in 
the morning, found his mouth suddenly and 
painfully fixed wide open. He arose in alarm, 
and ran to the nearest doctor, who happened to 
be a homoeopath. The homoeopath seemed con- 
founded by the curious predicament of the pa- 
tient, but after carefully examining him, pro- 
nounced it a case of lockjaw, and remarked that 
the jaw was locked open ! 



The inevitable sugar powders were prescribed, 
and the patient directed to return home and go 
to bed. After continuing under this treatment 
for a few days, a shrewd visitor expressed some 
doubt as to the correctness of the diagnosis, 
and insisted on his friend seeking other advice. 
The result was that Dr. Janney was called on, 
and the jaw that was " locked open," was soon 
shut, with a snap, by the simple reduction of 
the dislocation by means of the Doctor's 
fingers. 



November 17, 1860. 



NEWS AND MISCELLANY. 



183 



The Man throvgh whose Head an Iron Rod passed, 
Still Living. — Professor Hamilton, of the Ohio 
Medical and Surgical Journal, writes as follows : 

All who are old enough to have been readers 
of medical journals in 1848, will recollect the 
case of the man Gage, through whose head 
passed a tamping rod, three feet seven inches 
in length, an inch and a quarter in diameter, 
and weighing 13|^ pounds. 

A few months ago we had occasion, in some 
clinical remarks, to make mention of this re- 
markable case, in which we stated that, though 
the man survived, we were not informed as to 
the mental and general condition in which the 
injury left him. 

Dr. Henry Trevitt, of Valparaiso, South Ame- 
rica, who was present, at once replied to our 
remark that he knew Gage well ; that he lived 
in Chili, where he was engaged in stage driving; 
and that he was in the enjoyment of good health, 
with no impairment whatever of his mental 
faculties. 

Dr. Harlow, of Cavendish, Vermont, in whose 
practice the case occurred, described the wound 
as commencing just anterior to the ramus of 
the inferior maxillary bone of the left side, 
taking a direction upward and backward to- 
ward the median line, passing through the left 
anterior lobe of the cerebrum, and making its 
exit at the junction of the coronal and sagittal 
sutures ; lacerating the longitudinal sinus ; ex- 
tensively fracturing the frontal and parietal 
bones ; breaking up a large portion of the brain, 
and protruding the globe of the left eye from its 
socket by nearly one-half its diameter. 



Protrusion of Bone hy Growth from the end of a 
Stump. — When limbs have been submitted to 
amputation in childhood, it not unfrequently 
happens that, as the individual grows, so does 
the bone elongate itself in a proportionate man- 
ner, and then protrudes through the soft parts, 
after a time forming a conical stump. Instances 
of this kind we have already brought under the 
notice of our readers ; and that the bone does 
grow is believed by many surgeons of high 
authority, amongst whom are Mr. Stanley, Mr. 
Curling, and others. An undoubted example of 
it was recently admitted into Guy's Hospital, 
under Mr. Hamilton's care. The patient was 
a healthy-looking girl, of about the age of 
eighteen years, whose right arm had been am- 
putated in childhood. The stump healed kindly, 
and remained healthy for some years, when it 
gradually became conical, and from the point 
protruded the end of the humerus. Its appear- 
ance was like an exaggerated nipple somewhat 
drawn out. There was no retraction of muscu- 
lar substance here, but clearly an outgrowth 
of bone. The soft parts were tender in spots, 
as if from the pressure on or stretching of some 
of the nerves ; in fact, they could be marked by 
pins. The rest of the stump was healthy. 
Chloroform was given on the 24th of July, an 
incision was made on either side, freely laying- 



open the stump, and three inches of the bone 
sawn off; the parts were brought together, and 
the girl is now doing very well. — Lancet. 



Volatility of Mercury. — Professor Mallet con- 
firms the observations of Stromeyer on the 
evaporation of mercury with the vapor of 
water at comparatively low temperatures. Some 
mercury got mixed in his laboratory with a 
porous clay, which was dry to the touch, but 
which gave off 8 or 10 per cent, of water when 
heated to 100° C. A specimen of this was 
placed in a common copper box with double 
sides, which serves as a steam-bath, and ex- 
posed to the temperature of boiling water. In 
half an hour the glass tube through which the 
heated air and vapor from the inside of the 
steam-bath escapes, was covered with a bright 
specular deposit of metallic mercury. From 
this it is clear that the metal does volatilize in 
considerable amount when surrounded by the 
vapor of water at 100°. — Chemical News. Dub- 
lin Press. 



Infantile Mortality in London. — In the fifth re- 
port of sanitary progress of the National Phi- 
lanthropic Association, it is stated that of 100 
children born in Church-lane, 31 die before the 
first year ; in the whole of St. Giles's, 28 ; Lam- 
beth, 20 ; City of London, 19 ; Islington, 16. 
Out of 100 children living, at one year and under 
two, there die in Church-lane, 46 ; St. Giles's, 
15; Lambeth, 10; City of London, 12; Isling- 
ton, 7. The report adds that it will be seen 
that, while only 7 in 100 die in Islington from 
one to two years, 46 die in Church-lane, which 
should be called Church-yard rather than 
Church-lane. — Lublin Press. 



Army and Navy. — Leave of absence for six 
months has been granted to Asst. Surgeon 
J. H. Berrien, on condition that suitable medi- 
cal attendance be furnished to the troops at 
Colville Depot, W. T., without expense to the 
U. S. during his absence. 

Asst. Surgeon D. P. Eamseur, has been 
ordered to relieve Asst. Surg. W. J. L. White, 
at Fort Clark, Texas; the latter, on being re- 
lieved, has been instructed to report, in person, 
to the Surgeon General of the Army. 



Peyinsylvania College of Lental Surgery. — The 
annual course of lectures in this Institution 
commenced on Monday, the 5th inst., under 
the most favorable circumstances. The class 
being much larger than at any previous open- 
ing, and the interest manifested by those pre- 
sent, gave ample evidence of their desire to be 
up with the present advanced state of the 
science. We feel safe in predicting that the 
Faculty will leave nothing undone to merit the 
increased patronage extended to this flourish- 
ing school. 



184 



NEWS AND MISCELLANY. 



Vol. V. No. 



Heturn of the Surgeon of the Hayes' Expedition — 
The Yesselin Winter Quarters and the Party all Well. 
— Dr. Wm. Longsliaw, Jr., of East Cambridge, 
who went out in Dr. Hayes' expedition as sur- 
geon, lias arrived home, and reports the officers 
and crew all well. He left the vessel after her 
arrival at w^inter quarters. She was, at the 
time he left, frozen in ice, where she would re- 
main until June next. 

Dr. L. brought dispatches from Dr. Hayes for 
the committees at Boston, New York, Philadel- 
phia, and Baltimore, who aided in fitting out the 
expedition, and to the general government at 
Washington. These he left with the American 
consul at Copenhagen, and thev should have 
reached their destination ere this time. He 
also brought letters to other parties. 

At the time he left everything seemed favora- 
ble for the prosecution of the objects of the ex- 
pedition another year. Dr. L., accompanied 
by an envoy, furnished by the Danish govern- 
ment, went across Greenland to a Danish port, 
from which he sailed for Copenhagen. After- 
wards he visited Paris, and he came from 
Europe in the City of Edinburgh, arriving home 
on Thursday, week before last. 



deduction of Strangulated Hernia hy Inverting the 
Patient. — A case of successful treatment of stran- 
gulated hernia by manipulating the tumor 
whilst the patient was raised perpendicularly 
on his head and shoulders by assistants, is re- 
ported in the Lancet as " a neio method.' ' 

Perha]3S there is not a surgeon in this coun- 
try who is not familiar with this maneuvre, 
and it also seems to be popularly known. We 
once heard from a sailor that it was a common 
practice at sea in the reduction of ordinary 
cases of hernia. 



Prosecutio7i of a Bone-setter. — A boy at Birken- 
head, England, was injured, and a bone-setter 
was called in who said that the thigh bone was 
broken, and accordingly professed to set it. For 
this he received his fee. The boy became ra- 
pidly worse and died in a few days. A post- 
mortem examination showed that the bone had 
never been broken. On account of mal-treat- 
jaient of the case the coroner's jury rendered a 
verdict of "manslaughter'^ against the quack. 



Lectures to the Insane. — We had the plea- 
sure, on Tuesday evening last, of being pre- 
sent at the Pennsylvania Hospital for the In- 
sane, (Dr. Kirkbride's,) at a lecture on the 
"Habits of Insects, ^^ delivered before the fe- 
male patients of the hospital by Dr. Isaac P. 
Trimble, of Newark, N. J. A more attentive 
audience we have never seen, and it is evident 
that such intellectual diversions must contribute 
much to arouse the slumbering faculties of the 
patients and contribute to the restoration of 
their mental powers. The lecture was pecu- 
liarly attractive on account of the close observa- 
tion with which Dr. Trimble has studied the 
subject, enabling him to illustrate the wonder- 
ful habits of these animals by striking and 
curious examples. 



The Museu'in of Comparative Zoology at Cam- 
bridge was opened at Boston on Tuesday last. 
The exercises consisted of addresses by Grover- 
nor Banks, President Felton, Professor Agassiz, 
and Dr. Jacob Bigelow. A large and interested 
audience was present. The museum is endowed 
with $225,000, of which $100,000 is by the 
State and the remainder by individual dona- 
tions. 



For the Examination of Milk, Mr. Fellenberg 
[Schioeizer Zeitschr. fur Pharmacie) recommends 
an areometer constructed on a princijDle which 
renders it much more suitable for the examina- 
tion of liquids but little lighter or heavier than 
water, than the common hydrometer. The 
difference is simply in the proportion as to size 
between the bulb and scale. For, while in the 
common hydrometer the volume of the float 
and that of the scale are in the proportion of 10 
to 6, in the new areometer it stands at 150 to 1, 
corresponding to a volume of water of resp. 
1500, and 10 grains. 



A New Remedy for Croup. — Botjchtjt, a French 
surgeon, is said to be curing croup by removal 
of the tonsils. Eleven successful cases have been 
published. 



Formation of Crystals. — Hauer says, that when 
a broken crystal is placed in a solution of an 
isomorphous salt it quickly recovers its original 
form ; but when a crystal is cut so as to give 
faces belonging to combinations of the same 
crystalline system, only these new faces are de- 
veloped. A crystal with artificial faces placed 
in a solution of an isomorphous salt behaves 
exactly like a natural crystal. In this way we 
may produce mechanically at will any crystal- 
line combinations whatever. 



Quinic Acid in the Herb of the Whortleberry. — 
Messrs. Zwenzer and Siebert [Annalen der Che- 
mie u. Pharmacie, July, I860,) have found that 
several plants belonging to the family of Erici- 
neae, among which the Vaccinium Myrtillus, 
whortleberry, contain a considerable proportion 
of quinic acid, identical with that obtained from 
Peruvian Bark. 



Errata. — In the last number of the Reporter, 
in the article of Dr. Thompson, on page 138, 
second column, 20th line from the bottom, after 
the word " affections, ^^ insert "of the throat, be- i 
cause he says it produces such affections," 
making it read: "The Homo^opathist gives 
belladonna in certain affections of the throat," 
etc., etc. And in the 17th line, read " expla- 
nation" instead of " operation." 



November 17, 1860. 



COMMUNICATIONS EECEIVED. 



185 



A Village Hospital. — The management of cases 
of accident and severe illness amongst the poor 
in rural districts constantly offers the most se- 
rious difficulties to the surgeon. If there should 
happen to be a large hospital near at hand, or 
within a convenient distance, the difficulty is 
quickly solved by transporting the patient to 
that establishment, where all his wants are an- 
ticipated, and the necessities of his case sup- 
plied. In remote villages, in isolated districts, 
and in localties where the hospital is far dis- 
tant or its accommodation insufficient, the pa- 
tient must suffer greatly from the absence of all 
the appliances and the kind of nursing and at- 
tendance which only such an institution can 
afford. A well-devised effort, made at the vil- 
lage of Crawley, successfully meets these short- 
comings in that district, and may serve as a 
model to be usefully copied elsewhere. The 
Crawley Village Hospital consists of a cottage, 
which the rector lends rent free. It is designed 
for the accommodation of the poor when suf- 
fering from sickness or from accident. The 
establishment is composed of a nurse and a 
servant ; a lady has also promised the benefit 
of her assistance in special cases. The institu- 
tion has now been working a year, during 
which period twenty-two cases of accident and 
disease have been successfully treated, at an ex- 
penditure apparently not exceeding £00. The 
number of beds is now fixed at six. Placed in 
the midst of a healthy atmosphere, and each of 
them the object of anxious and special care, the 
patients are favorably situated for cure. Craw- 
ley Village Hospital is a sensible and useful 
development of local philanthropy, for which 
we desire permanence and a rich fruition of 
useful works. Like the Military Hospital at 
Eenkioi, such an establishment enjoys«the im- 
mense advantage of being capable of indefinite 
increase according to need, without impairing 
its sanitary principle of isolation. You have 
but to add cottage to cottage. — Lancet. 



Pamphlets Received. — An Inquiry concerning 
the value of testimony respecting facts as they 
appear to a mind partly conscious, by T. L. 
Wright, M. D., Bellefontaine ; from the Trans- 
actions of the Ohio State Medical Society. 

Classification of the Animal Kingdom, by 
Dr. Hayes Agnew, M. D. : Lecture on Ana- 
tomy, Clinical Lecturer on Surgery in the Phila- 
delphia Hospital, etc. ; an Introductory Lec- 
ture. 

An Essay on the Treatment of Phthisis by 
Chlorate of Potash, etc., by E. J. Fountain, 
A. M., M. D., of Davenport, Iowa. 



MARRIAGES. 

Wilson — Dillinger.— On Tuesday evening last, 
6th inst., by the Rev. B. M. Schmucker, Dr. J. H. 
Wilson, of Schnecksville, to Miss Lovina S. Dillinger, 
of Allentown. 

Pepper. — Hamilton. — October 24th, by Rev. Wm. 
Minnis, D. D., J. G. Pepper, M. D., of Huntsville, 
Ala., and Matilda J. Hamilton, of New Market, 
Tenn. 

Carr — Sims. — On the 8th Nov., at New York, by 
the Rev. Dr. Potts, Charles H. Carr to Mary V., 
eldest daughter of Dr. J. Marion Sims. 



DEATHS. 

Rankin. — On the 17th of October, near Curlls- 
ville, Clarion county, Pa., Mrs. Eliza, wife of Dr. J. 
M. Rankin, in the 65th year of her age. 

Halberstadt. — At Pottsville, on Friday, the 
9th instant, Dr. George Halberstadt, in the 56th 
year of his age. 



A Hospital for Consumption at Torquay. — A Lon- 
don merchant, whose daughter was greatly bene- 
fitted by the climate of Torquay, has offered 
five hundred pounds to aid in completing the 
hospital at that place. 



ETtJSbDcrj? to S^orr£«ponl]fjent5. 

Dr. J. A. TF.— Your letter has been received, but it is impos- 
sible, at present, to give you precise information on the subject. 
More in a few weeks. 

Dr. F., Iowa. — Vaccine matter has been sent. 

Dr. A. W. W., JSr. J.— We are anxiously waiting. 

Dr. I. A. JY., JV. J. — There is room for those mortality re- 
ports. 

Dr. J. F. JV., La. — Hartshorne's Memoranda Medica has been 
sent by mail. Send us $1.00. 



COMMUNICATIONS EECEIYSD. 

Delaware— Dr. G. P. Norris, (2.) Georgia — Dr. J. E. Black- 
shear. iZWreois— Dr. C. S. Spillman, (with end.) Indiana— Dr , 
E. B. Glick, (with end.,) Dr. J. Lewis. lowa—Dv. G. M. Staples- 
Kentuckij-Dr.W. D. Gray, (with end.,) Dr. G. W. Ronald- 
Louisiana— Dv. N. B. Benedict, Dr. J. F. Newton. Maryland— 
Dr. H. B. Wilson. Massachusetts— J)r. W. T. Brackett, (2.) JVew 
York— Dr. Macnicholl, (4,) Dr. H. Swits, (with end.,) Dr. J. G. 
Snell, (with end.,) Dr. C. Devendorf, (with end.,) Dr. M. T.Peak, 
(with end.,) Dr. G. J. Newton, (with end.,) Dr. W. H. Johnson, 
(with end.,) Dr. S. W. Maxwell, (with end.,) Dr. W. A. Ilubbs, 
(with end ,) Dr, S. A. Ingham, (with end. ) Dr. P. Billinggerj 
(with end.,) Dr. J. B. Casey, (with end.,) Dr. J. H. Douglass, 
(with end.,) Dr. J. B. Nold, (with end.,) Dr. D. C. Brown, (with 
end.,) Dr. H- F. Teed, (with end.,) Dr. N. R. Cresswell, (with 
end.,) Dr. W. J. Kingsley, (with end.,) Dr. S. P. Scudder, (with 
end.,) Dr. J. V. Cobb, (with end.,) Dr. G. F. Collins, Dr. H. Hern- 
street, (with end.,) Dr C. W. Bates, Dr. J. Atherley, C. 
Evans, (with end.,) Dr. R. W. Clark, Dr. E. S. Gaillard, (with 
end.) Ohio — W.E. Chapman. Pennsylvania — Mr. Jno. Hulme, 
(2,) Dr. F. C. Harrison, (with end.,) Dr, W. A. Case, (with end,,) 
Dr. J. R. Evans, (with end.,) Dr. J. Smith, (.with end.,) Dr. D. 
H. Montgomery, (with end.,) Dr. J, H. Keeler, Dr. H. Clapp, Dr- 
W. H. King, (with end.,) Dr. G. B. Swayze, (with end.,) Dr, J. C. 
Snaeffer, (with end.,) Dr. G. Weserman, (with end.,) Dr. G. Wei- 
ser, (with end.,) Dr. H. 0. Witman, (with end.,) Dr. H, R, Caslow, 
(with end.,) Dr. J, K. Hertz, (with end.,) Dr. P. F. Waggouseller, 
Dr. H. Neal, (with end.,) Dr. S. H. Harry, Dr. F. W. Quig, (with 
end.) Ehode Island— Dr. E. M. Snow. Tennessee— Dr. J. A. 
Hudson. Vermont— Dr. C. L. Allen, Dr. S. R- Day, Dr. A. E. 
Horton. 

Ofice Payments— W. M. Christman, J. Roberts, Dr. H. A. 
Fahnestock, (Pa.,) Dr. G. F. Fort, (N. J.,) Dr. R. Barr, (Pa.,) C- M. 
Robinson, Dr. W. T. Howard, (N. C.,) Dr. F. B. Poley, (Pa.) By 
Mr. Swaine: Drs. S. B. Ladd, A. G. Heston, J. Kammerly, J. 
Gilliaras, Evans, McBride, J. Kline, (adv.,) R, H. Button, (adv.) 
By Mr, Foster: A. R. Gray, A, T. Robertson, T. J. Swisher. 



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THE 



MEDICAL AND SURGICAL REPORTER. 



WHOLE SERIES, 
NO. 214. 



NEW SERIES, 



PHILADELPHIA, NOYEMBER 24, 1860. { vJl v no g 



» 



ORiCBNAL DEPARTMENT. 

LECTURES. 

Lectures on the Crystaline Lens and its 
Diseases. 



By Laurence Turnbull, M. D., 

t Ophthalmic Surgeon to the Howard Hospital. 

No. 4. 
OPERATION or EXTRACTION. 

Freytag was the first operator who made an 
attempt to extract the cataract. After him, 
Lotterins, of Turin, performed the operation of 
extracting a crystaline lens that was opaque. 
But. as stated in a previous lecture, Daviel first 
communicated this method to the public. Then 
followed Wenzel, who was very successful with 
This form of operation. The instrument he 
employed, his son called a " ceratotome ;"* it 
resembles the common lancet employed in 
bleeding, excepting that its blade is longer and 
not quite so broad. The blade is an inch and 
a. half (eighteen lines) long, and a quarter of 
an inch (three lines) broad, in the widest part 
of it, which is at the base. From whence it 
gradually narrows towards the point, so that 
the breadth of a quarter of an inch extends 
only to the space of about one-third of an inch 
(four lines) from the base; and for the space 
of half an inch (six lines) from the point, it is 
no more than one-eighth of an inch (one line 
and a half) broad. This instrument, he states, 
can be employed for either eye; but the same 
instrument should never be employed to ope- 
rate on both eyes on the same day, for, what- 
ever care may be taken to cleanse the blade 
after the first operation, it becomes soiled with 
an unctuous, greasy substance, which prevents 
it from cutting clean. The Baron has no faith 

« A Treatise on the Cataract, by M. De Wenzel, Jun., Baron 
of the Holy Roman Empire, etc. Translated from the French, 
by James Ware. London, 17 9L 

15 



' in any of the instruments to fix the eye, believ- 
ing that they render the operation more com- 
plicated in itself than useful in fixing the eye. 

Mr. France, the Ophthalmic Surgeon of Gruy's 
Hospital, has shown how various have been 
the contrivances to fix the eye in the operation 
of extraction, and how all, owing to some dis- 
advantage attending them, have become obso- 
lete. He has also recommended the employ- 
ment of simple artery forceps without spring- 
catch, which, he says, should be rather long, 
with broad nibs and prominent or projecting 
teeth, so as the better to take hold of the sub- 
conjunctival fascia simultaneously with the 
mucous membrane. His recommendation is 
supported by the details of twenty-seven cases, 
some of which I saw, while on a visit to Guy's 
Hospital, in 1859, with Mr. France, and thej 
were as well-executed